Applied Narrative Psychology [New ed.] 1009245317, 9781009245319

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APPLIED NARRATIVE PSYCHOLOGY

Narratives are grounded in everyday life, from our conversations to films to books. We all create and tell stories, and we listen to other people’s stories. Using narrative approaches is both meaningful to people and clinically effective. This book provides a broadranging introduction to narrative psychology and applies narrative to ­professional contexts to help people develop efficient techniques to use in practical situations, including clinical and occupational psychology. It offers a rationale for the use of narrative approaches, translating core research into accessible techniques, and illustrates these approaches with practical examples across a range of areas. In turn, it details how practitioners can help people change or develop their narratives to enable them to live their lives more effectively. Nigel Hu n t  is a health psychologist and associate professor at the University of Nottingham, UK. His research focuses on narrative psychology and traumatic stress. Alongside his collaborators, he has tested and applied narrative techniques in many countries. He has written nine books, including Memory, War and Trauma (2010), Guided Narrative Techniques (2012) and Landscapes of Trauma (2019).

Published online by Cambridge University Press

Published online by Cambridge University Press

A PPL I E D N A R R AT I V E P S YC HOL O G Y N IGE L H U N T University of Nottingham

Published online by Cambridge University Press

Shaftesbury Road, Cambridge CB2 8EA, United Kingdom One Liberty Plaza, 20th Floor, New York, NY 10006, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia 314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre, New Delhi – 110025, India 103 Penang Road, #05–06/07, Visioncrest Commercial, Singapore 238467 Cambridge University Press is part of Cambridge University Press & Assessment, a department of the University of Cambridge. We share the University’s mission to contribute to society through the pursuit of education, learning and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781009245319 DOI: 10.1017/9781009245333 © Nigel Hunt 2024 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press & Assessment. First published 2024 A catalogue record for this publication is available from the British Library Library of Congress Cataloging-in-Publication Data Names: Hunt, Nigel, 1963– author. Title: Applied narrative psychology / Nigel Hunt, University of Nottingham. Description: Cambridge, United Kingdom ; New York, NY, USA : Cambridge University Press, 2024. | Includes bibliographical references and index. Identifiers: LCCN 2023027759 (print) | LCCN 2023027760 (ebook) | ISBN 9781009245319 (hardback) | ISBN 9781009245333 (ebook) Subjects: LCSH: Narration (Rhetoric) – Psychological aspects. Classification: LCC P301.5.P75 H86 2024 (print) | LCC P301.5.P75 (ebook) | DDC 808/.036019–dc23/eng/20230914 LC record available at https://lccn.loc.gov/2023027759 LC ebook record available at https://lccn.loc.gov/2023027760 ISBN 978-1-009-24531-9 Hardback ISBN 978-1-009-24532-6 Paperback Cambridge University Press & Assessment has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

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Contents

Preface page vii 1 Introduction

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2 What Is Narrative?

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3 Narratives in Psychology

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4 Master Narratives

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5 Narrative Methods

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6 Life Interviews

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7 Narrative Writing

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8 Narrative Therapy

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9 Narrative Exposure Therapy

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10

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Narrative Medicine

11 Narrative Health Psychology

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12 Narrative Work Psychology

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13 Narrative Coaching

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14 Conclusion

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References 170 Index 187

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Published online by Cambridge University Press

Published online by Cambridge University Press

Preface

Since drafting this book, I have experienced a diagnosis of terminal bowel cancer for which, at the time of writing, I am undergoing treatment to try to control. It is an experience that has enabled me to put narrative into practice. Cancer is a difficult illness to deal with, and we all respond in ­different – yet similar – ways. One of my main responses has been to start a blog, a narrative account of my experiences. The blog is about my thoughts, feelings and behaviour in relation to what I am going through regarding my cancer. It is (I hope) explicit, honest and detailed. It covers everything from the experience of a sigmoidoscopy to my reflections on being an atheist and my lack of fear of death. I am terrified of pain but death is non-existence, so it would be absurd to be frightened of being dead. It is not how everyone would respond to a cancer diagnosis, but it is the way I am responding, and as a narrative approach, I find it very successful. What follows will, I hope, show you how other people may draw on narrative approaches to help them not only with health-related problems but also with other ­problems associated with human experience, such as work. The book is structured to provide an account of what narrative is and various ways of doing it. These methods can be adapted to different circumstances, but they are all practical ways of applying the ideas of narrative to psychology-related problems. This is not a book preaching particular methods or philosophies. In the end, these do not matter to the applied psychologist: what matters is what works. Nevertheless, where possible, I have presented the evidence relating to the various methods. The problem is that several of these methods have a limited evidence base, which does not mean they have no value, but does mean that we need to be careful in how we interpret and use them, and that we should, as psychologists, be trying to build up the evidence base. Narrative is central to what we do as humans, so it should be central to psychology. I would like to thank all my colleagues and students who have worked with me on narrative-related topics over the last couple of decades. I would vii

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also like to thank the staff at Cambridge University Press for turning a rough manuscript into a book. Personally, I would like to thank my wife, Sue, and all my family and friends for being so supportive in this difficult time, and finally the wonderful staff at the Royal Derby Hospital, who have helped me stay alive long enough to get the manuscript finished. The staff at the hospital, my GP practice and in the community are amazing, highly dedicated people who have to put up with a lot from so many ill and frightened people. I would like to dedicate this book to them.

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Chapter 1

Introduction

There are arguments over what it is to be human. Aristotle argued that it is the power of speech and the sense of good and evil or justice and injustice. Descartes, with his ‘cogito ergo sum’, argued in his Meditations that humans were the only animals with minds. Kant argued that with our technical, pragmatic and moral skills that we can join our minds with mechanics to manipulate things, we can treat other people pragmatically for our own purposes and we can treat each other according to principles of freedom under a set of laws. Linked to this is the idea that the opposable thumb gives us the ability to use tools in ways no other animal can. For Charles Darwin, the difference between humans and other animals was one of degree rather than kind, that things such as emotions, curiosity and reason are just better developed in people than they are in other animals. All these have some truth, but while language is a critical component of what it means to be human, our narrative ability is what makes us stand out from other animals, our ability to tell stories, not just stories that are fictional, but stories that tell us something about the world, whether through the arts, the humanities or the sciences. Aristotle was right about the importance of speech. Other animals use speech to some degree, but they don’t have complex systems of semantics and syntax, or the complexity of memory that we have for stories. Narrative is a universal human activity. We are intrinsically story creators, story tellers and listeners to stories. It is what we do every day. Roland Barthes, in his classic essay on narrative (Barthes, 1975), said ‘There are countless forms of narrative in the world…. Among the vehicles of narrative are articulated language, whether oral or written, pictures, still or moving, gestures, and an ordered mixture of all those substances; narrative is present in myth, legend, fables, tales, short stories, epics, history, tragedy, drame [suspense drama], comedy, pantomime, paintings, stained glass windows, movies, local news, conversation. Moreover, in this infinite variety of forms, it is present at all times, in all places, in all societies; indeed narrative starts with the very 1

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Introduction

history of mankind; there is not, there never has been anywhere, any people without narrative’ (p. 237). Barthes was writing from the perspective of art and literature. The comments are applicable to the science of psychology. What is difficult to understand is why, in the 150 or so years of the history of psychology, so few psychologists have concerned themselves directly and explicitly with narrative. It is discussed in several areas such as language development, some aspects of reasoning and some memory studies, but its general absence is inexplicable. Narrative is at the heart of human endeavour. Jameson (1981) describes narrative as ‘the central function of the human mind’ (p. 13), and he is right. Memory, attention, perception and so on all depend on us putting information together in narrative form. One of the problems with studying narrative is that many psychologists believe it is non-scientific. It falls into the area of qualitative psychology which many psychologists still believe is beyond the bounds of science. This is something that needs to be addressed. There are narrative researchers who exclude themselves from traditional notions of science and have strong views about the importance of the political imperative when conducting human research using qualitative methods including narrative. I don’t want to get into those arguments here. My perspective is that narrative is, or should be, central to the scientific study of people, central to psychology. Science in its broadest form is about the systematic development of knowledge through the use of systematic methods and the development of testable theory. While narrative and qualitative methods generally may create some difficulties relating to both method and theory, there is no good reason why they should not be firmly in the camp of good science. It is about the ways we do narrative research, which I will return to throughout the book. The focus here is on applied narrative psychology, which is a particular perspective, but if we are going to apply narrative psychology, then we need to know that it is having a positive effect, or why bother with it? We need evidence that it works in the real world. The problem is, as we shall see, that while there is good evidence for some aspects of narrative work, in particular narrative exposure therapy (NET) and expressive writing, the evidence for several other applied approaches is often limited, or in some cases virtually absent. This means that you are reading a book that claims to base itself on science, yet the science for many of the claims is limited. My argument is that we are at an early stage of narrative science – partly because many narrative psychologists have not obtained the appropriate evidence – but that does not mean that what we do is of no use, it means we should start collecting some good data to provide support

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for our ideas on narrative so that we can develop narrative theory, method and application. What is narrative? This is part of the problem. When doing science, we need clear definitions of our constructs. We do not have good agreement about the construct of narrative. There are different definitions, for instance, about whether a very simple language structure can be called a narrative or whether language needs a number of characteristics to be called a narrative. Abbott (2008) makes the point that the basic narrative could be just putting a verb and a noun together (‘Drink tea’), which young children achieve when around 3–4 years old, which is the age from which we retain our earliest memories, so perhaps memory itself may depend on basic narratives. Mnemonic systems often rely on creating meaning by putting information into some form of story (e.g. making a list and putting the items along an imaginary walk, or turning them into the components of a story). Memory is usually improved for information that has some meaning attached to it, and narratives provide meaning. It is also difficult to look at a picture without imparting some meaning. We don’t just process information; we make sense of it. If we look at the Mona Lisa, a picture most people in the West are at least somewhat familiar with, we don’t just look at a head and shoulders picture of a woman. We wonder whether she is smiling, why she appears to be looking at us. We wonder where she is from, what the background represents. We wonder what her story is. Herman (2007) has a slightly more complex definition of narrative. Informally narrative is a synonym for a story, but she proposes more formally that a narrative is a representation of (a) a structured time course of particular events that (b) introduce conflict into the storyworld (whether actual or fictional) conveying (c) the qualia – what it is like to live through the disruption. This is a helpful definition as it has a place, a series of presumably interconnected events and – which is important to make fiction interesting and to provide psychologists with a role – there is conflict which somehow needs to be resolved. Are stories the same as narratives? We often use the terms interchangeably but there is no real agreement. At its most basic a narrative is perhaps a representation of an event or a series of events. The event (or action) is the critical element. Without something happening, the event, then we just have a description (‘the book is red’), which many would argue is not sufficient to be a narrative. To create a narrative we need something to happen (‘The red book was read by a person’). Barthes (1975) suggests that a single event is not enough, that there needs to be two or more events.

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Others suggest that there needs to be some causal relationship. Abbott (2008) argues that this overcomplicates it, and we should stick with the simplest definition rather than a more restrictive one that demands causality or multiple events. Whichever way we define narrative we are unlikely to have a single definition that fits all cases. I favour a pragmatic approach – which is generally the way to approach applied science. If it works use it. Rather than having a specific definition of what is and what is not a narrative the important element is that it has some value in relation to what we are doing. If ‘the book is red’ is sufficient for purpose, then it is a narrative. If we need an event such as the book being read by a person, then we will use that as the basic narrative. When we are looking at the narratives created by, for instance, traumatised people, we may need more complex narratives to make psychological and scientific sense. For instance, we have been argued that traumatised people have problems constructing a coherent narrative (e.g. Burnell et al., 2006) and that their accounts of traumatic incidents are so disjointed they cannot be called narratives. For us to come to this conclusion, the narratives of these people must be complex. They are likely to include a narrator, multiple characters (who have explicit characteristics and relationships with each other), detailed plots and possibly subplots, several elements of causality derived from chronology and so on. A lot more than ‘man bites dog’ or ‘the book is red’ – though we should not reject these as narratives if the setting is appropriate. The critical point is that defining narrative for the purpose of applied psychology depends on the context in which it is to be used. Chatman (1990) argues there is the chronologic of narrative. He argues that narratives have a doubly temporal nature. In the first place, a narrative moves through time ‘externally’, that is, the duration of the reading of the novel, the telling of the story and so on. In the second place, it moves through time internally, in terms of how long the plot itself takes to unfold. For instance, it might take several hours to read a novel (external), but the novel itself is set over several years (internal). According to Chatman, the first is discourse and the second is story. He argues that texts such as an essay or a description of a rocket engine do not have this internal time sequence and so are not narratives. I disagree. A student essay is a narrative about the construction of an argument. It has no internal time element. Neither does this book. It would be unusual to say that a book such as this is not a narrative. Of course, Chatman was arguing from the arts, where the story element may need to be separated from the discourse; but I am a psychologist, and so see stories as narratives, whether or not

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there is a distinction between internal and external temporality (which are useful concepts in certain circumstances). While our understanding of narrative is not entirely operationalisable, which is usually not a good thing in terms of science, we all know what a narrative is, from formal narratives such as a book, a magazine article or a lecture, to less formal narratives, such as a conversation in a café or a discussion about football. The main point is that narratives are not the sole province of professional writers and speakers, they belong to everyone. We all understand narratives, we can all create and adapt narratives, we can all express narratives to others and we can all listen to and understand other people’s narratives. If we accept what has been argued earlier, the terms narratives and stories are roughly interchangeable in practice. They tell us about something that happened. The ones we are interested in as psychologists generally provide characters, how characters interact, some sort of plotline, cause and effect and some sort of change. Normally, something has to happen for a narrative to be a narrative. It should also be reasonably coherent, so that an audience can understand what the narrator is trying to put across, their point, the meaning of the story. Narratives have both universal and cultural aspects (Hunt, 2010), enabling us to cross the bridge between realism and relativism, or naturalism and constructionism. Narrative processes themselves are universal; the stories we tell are told by all cultures across the world. The expression of these narratives does vary, enabling cultural expression to take on different senses in different parts of the world. The universality of narrative processes means we can understand narrative from a neuroscience perspective, though the evidence as yet remains limited. We are trying to understand the mechanics of narrative, the theory, the method and its applications within the context of psychology, particularly within the context of applied psychology. It is all very well saying that we all use narratives, but what does that mean in psychological terms? What is the purpose of a narrative? How might it benefit a listener or the person who constructs the narrative? Having established a very general definition of what we mean by narrative (this will be explored in more detail in Chapter 2), we need to think about how we can use narratives in psychology. We use narratives all the time. We use a range of different narrative styles. We not only construct and employ narratives, we are the audience for other people’s narratives. Without narrative we would not be human. If we used language without narrative, it would be no more sophisticated than the sign languages learned by chimpanzees in the experiments of the 1950s and 1960s. Of

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course, some humans, due to some form of disability, are not able to use narrative. Such dysfunction does not negate the argument for the criticality of narrative as the norm. As applied psychologists, we use a range of methods to try and help people. Clinical psychologists use a range of therapies to try and reduce mental health problems, health psychologists try to reduce the psychological impact of ill health, forensic psychologists try to understand how the criminal mind works and occupational psychologists try to make the workplace a better place to be. They are all using narratives of one sort or another, even if these narratives are neither explicit nor even acknowledged. A key aim of this book is to demonstrate how we as psychologists use narrative in our work, both implicitly and explicitly. The other key aim is to show how using narrative approaches explicitly can improve the work we do. Narrative theorists, therapists and others draw on a wide range of approaches to narrative psychology. It is an area where ten experts will come up with fifteen approaches. This can get very confusing. This is an applied book. We want things that work. We are less interested in the deep theoretical and methodological conflicts and debates that occur within narrative psychology and more interested in how we can make use of narratives in our work, irrespective of our specialisms. That does not mean we can ignore theory. If we are going to use narrative approaches, then we need an understanding of theory and method, but this book will not provide a detailed explanation of the many approaches. The approach used is meant to be coherent but not completely explanatory. We need a scientific explanation for why people use narrative and how and where they use it. As I have already noted, and will emphasise throughout the book, the evidence for the effectiveness of many narrative approaches is rather weak. We need to develop a coherent set of methods for using narrative, but this does not yet exist. What I hope to do here is provide a way of understanding and using narrative, not the only way, but it is, I hope, a reasonably coherent and useful way – even if I am asking that if you do use narrative, try to employ it in such a way as to be able to collect empirical evidence for its effectiveness.

Empirical Problems One of the main problems working in the area of narrative psychology is that, apart from the notable examples of NET (discussed in Chapter 9) and Expressive Writing (Chapter 7), the evidence for the efficacy and utility of narrative approaches is at best weak, often contradictory and

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Empirical Problems

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sometimes virtually non-existent. As a scientist this creates a problem. We cannot go around saying we are doing science if the evidence for our theories is weak, contradictory or non-existent. How are we to deal with this? In the first place, acknowledging a lower level of evidence will – for the moment – have to be acceptable. For many of the approaches discussed in the book, there is at least some evidence. This will be described and evaluated. Furthermore, the area itself, narrative, has emerged from the arts, through sociology, to psychology, and in the arts, evidence is of a very different kind to evidence in science. Over the years, the evidence regarding the ontological status of narrative, its very existence and nature, has been built up, theorised and well-established. There are few people who would argue that the concept of narrative is not immensely valuable when understanding the nature of people and the way they express themselves. On the other hand, artistic theorising is not acceptable to most scientists, though perhaps they should be more open to developing understanding through the arts. Novels tell us a lot about the human condition. I have written elsewhere about the psychological understanding we can derive from Remarque’s All Quiet on the Western Front (Hunt, 2004). There is ample scope for developing psychological understanding through the arts. What is acceptable now is showing how narrative approaches can inform our psychological understanding and how, in the context of this book, it can inform our understanding of applied psychology. While there is a distinct lack of evidence for some applied narrative psychology, there are well-organised procedures that can be tested, such as narrative therapy and narrative coaching. One of the purposes of the book is to provide a detailed account of where we stand with regard to these procedures (and the evidence base) to act as a heuristic for further research. Finally in this section, we need to be aware of how widespread narrative approaches are across the whole of psychology – even though sometimes they are not explicit, as in much of clinical psychology. The purpose of clinical psychology is to help people with mental health problems make sense of their problems and find ways of overcoming them, or at least managing them, that is, to create new stories by which to live. Forensic psychology likewise. Occupational psychology is, in the end, aimed at making organisations coherent and ensuring the people within these organisations function well, that is, ensuring that the overall story of an organisation coheres with the stories of the people employed by that organisation. Coaching psychology is a relatively new area, which is about how people’s stories are problematic and need to be changed to create improved stories, more effective ways of being, whether at work or in one’s personal life.

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Introduction

The Rest of the Book The book is presented in two main sections. Chapters 2 to 4 explore what we mean by narrative. These chapters are not applied, but they provide useful background understanding of ideas in narrative thought, with some practical examples. The second part of the book is concerned with applying narratives to psychological problems in various ways from more generic ideas round interviewing and analysis to addressing specific applied examples. Chapter 2 examines the nature of narrative in more depth. Most narrative research has been conducted by people interested in understanding the nature of story and narratives through fiction. These provide important insights into how narrative works not only in fictional accounts but also in real life narratives. The rules governing narrative – such as they are – are discussed in some detail, particularly how they apply to the narratives we use in everyday life. There are fundamental disagreements among theorists about what constitutes a narrative, and as already suggested, I will take a liberal approach here. Nevertheless, the key linguistic ingredients of a narrative, character, plot, action and so on, all will inform our understanding. Narratives are not only defined by the facts that are contained in the story but also by the structure and function of the story that is told, that is what makes narrative interesting to psychologists. Chapter 3 examines the core reasons why narratives are important to psychologists. When someone is using a narrative, it is not just the facts that are important but also the structure and function of the story. As psychologists we recognise that narratives are universal, but we want to understand why people use the narratives they do in certain situations, and why narratives sometimes fail. Why does a person with depression focus on negative aspects of their life story, and how can we help them change that and in so doing perhaps lessen the impact of their depression? Why do people who are traumatised have such difficulty describing what happened to them, often reverting to non-narrative forms of expression, using ellipsis, or omissions from speech to avoid talking about certain subjects, or describing past events (analepsis) in what appears to be a random fashion, or demonstrating a lack of agency? This chapter brings together narrative theory as it is understood by psychologists. For instance, McAdams (2008a) argues that there are a number of key concepts necessary for narrative understanding in applied psychology. These include coherence, meaning, agency, construction, redemption and contamination. Psychologists are interested in how the self is constructed, identity and identity change, and the limits of construction itself with respect to human behaviour.

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The Rest of the Book

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Chapter 3 will also examine the role of key psychological theorists who have brought narrative into psychology such as Bruner (1986), Sarbin (1986), Reissman (2005) and others, and how their ideas have influenced psychological thinking. In the early days of narrative in psychology, Bruner argued that psychology can be split into paradigmatic and narrative psychology, with the former being traditional experimental approaches. This distinction is problematic and may be one reason why narrative has not yet become mainstream, mainly because narrative psychology itself is paradigmatic, something not recognised by many psychologists. The emphasis in narrative psychology has often been on how to do it rather than doing it. There is a diversity of theories in narrative psychology. It is also essential to examine the relationship between the individual and the social world. Narratives function at several levels: the personal, interpersonal, social and cultural. At the top level, these are known as master narratives. The distinction between these categories is somewhat fuzzy, but it can be argued there is no such thing as a personal narrative as all narratives are influenced by the world around us, and by our audience. Not only friends and colleagues but also the media plays an important part in constructing and reconstructing narratives. Moscovici’s (1984) theory of social representations provides a good example of how these issues have been discussed in psychology for a long time without necessarily drawing on narratives explicitly – even though narratives are essential to social representations. Narratives provide the best approach to understanding how we understand ourselves, our interactions with others and the world around us and how we make sense of all this. The constructs we use in psychology are part of the master narratives of the subject, the interaction between psychologists, the users of psychology and society itself. There are two key points to be made here. The first is the nature of psychology itself and the second is how many of our theories are narrative in nature, at least implicitly. This is not to undermine psychology, but to point out the importance of narrative across the subject. The narrative of mainstream psychology in the UK for many people is that it is a scientific subject, accepting the scientific method, with the experiment as the best approach, and theories and methods derived from the natural sciences. While this has advantages, it also has disadvantages. In terms of specific theories, post-traumatic stress disorder (PTSD) provides a good example. PTSD was created in 1980 by the American Psychiatric Association (APA, 1980) to describe the responses people have to traumatic events, specifically at the time the response to war trauma, though in subsequent years, this has developed to include the response to other

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Introduction

forms of traumatic incident such as rape, sexual abuse, manmade or natural disasters, road traffic accidents and so on. There is a debate about which events should be included or not included, and over the years, the definition of PTSD in different editions of DSM has changed several times as a result of developing narratives. The fundamental problem is that PTSD is a constructed disorder. It is based on evidence relating largely to US veterans of the Vietnam War, and over the years, it has been adjusted to hone the symptoms more effectively to what is seen as the response to a traumatic incident. At the level of the narratives involved (narratives about trauma, PTSD, individual responses to trauma, emotions associated with trauma and so on), these narratives are not universal, and they are constantly changing. This fundamentally challenges the medical model. It is not that we are simply finding out more about PTSD, it is that the narrative of PTSD constantly changes to bring in more people, more traumatic event types, yet at the same time fails to account for the genuine problems people face as a result of challenging life-threatening experiences. People with a diagnosis of PTSD usually have a comorbid diagnosis of some other constructed disorder such as depression or anxiety (e.g. Ginzberg et al., 2010). If we have this constantly changing narrative, then in what sense are we understanding the nature of mental illness? Chapter 4 will explore master narratives, the overarching narratives that determine how cultures function. Every culture has one or more master narratives, which determine how participants think and behave to a large degree. While not everyone will agree with all elements of the master narrative – there are often subcultures, particularly in modern sophisticated liberal societies – the concept is essential for understanding the social world. The interaction between the individual narrative and the master narrative is essential for both social and individual change. We will see the effects of master narratives in certain societies and some of the problems associated with them, such as the problems of multicultural societies where there are fundamentally conflicting master narratives. Chapter 5 looks at narrative methods. It examines where and how narratives can be used in psychological research. It includes a general outline of the ways narrative is used as a method, the different conceptualisations and the limitations of narrative as a method. There are many accounts of how to use narrative as a method – perhaps too many, as some are contradictory, and the multiplicity of approaches makes it difficult to establish best practice. Narrative analysis is, as to be expected, mainly a qualitative approach (e.g. Wong & Breheny, 2018), where the researcher attempts to make sense

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of a script in narrative terms and draw conclusions about, for instance, the coherence of the narrative, or the meaning that is being put across. This is inevitably a difficult task due to the complexity of narrative. There are examples of attempts to quantify narrative analysis, but these are fraught with difficulty – providing a good example of how many aspects of psychological life cannot be reduced to numbers – whatever some psychologists might say. Moving on to the second part of the book, general approaches, Chapter 6 will examine life interviews, their characteristics and how they differ from other qualitative interviews. There are two main approaches examined in some detail. Don McAdams (2008b) has worked for many years on an effective life interview which examines individual narratives, which also examines how we can interpret interviews in terms of, for instance, redemptive narratives and contaminated narratives. This is a very detailed and sophisticated method and theory and is useful in practice. The other approach is one I have been developing called the Narrative Life Interview (NLI), which draws on McAdams’ work and others and is intended as a means of exploring transitions in people’s lives and to help people come to terms with, to manage, some of the problems they have faced in life. The NLI involves two interviews, a main one and a follow up. The purpose is to explore significant transitions in a person’s life. It does not matter what the transition is, but the NLI explores its effects on behaviour, cognitions and feelings. Any transition in life can have an effect on a person, and we as psychologists should be trying to understand these effects. The NLI has been used on subjects as broad as traumatised refugees and young adults transitioning to university. It is a useful research tool. The first interview, which can last a number of hours depending on the person and the topic, is designed to obtain as much information about the transition as possible, what life was like before the transition, during the transition and afterwards, including any longer-term changes. Through the interview, the person is asked about behaviour, cognitions and emotion, to obtain a broader and deeper picture. At the end of the interview, it is transcribed and turned into a story by the interviewer. This is the significance of the narrative element. The resulting document is not just a transcription of the interview but, using the interviewee’s words as much as possible, it is the story of the transition, written from the perspective of the interviewee. This story is then given to the interviewee so they can look for inaccuracies, lack of detail, elements they wish to remove and so on. At the same time the interviewer thinks about any questions they might have, for instance, to obtain more detail at some points, or for

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clarification. At the second interview, these areas are dealt with. Anything the interviewee wants removed is removed, anything they want changed is changed. The interviewer asks for detail or clarification. After this interview, the account is revised and sent to the interviewee for confirmation that it is an accurate and complete account. Emerging evidence suggests that this process, again perhaps as it is helping develop the narrative, is beneficial to people who are traumatised or otherwise affected by their experiences. It is not a substitute for therapy but can be helpful. Therapy versus research will also be explored in this chapter. There is a distinction among psychologists between the two, that people conducting research should not be doing therapy. This ignores the well-established fact that the process of being a research participant, particularly in interview studies, does have therapeutic benefits. Chapter 7 builds on the work in Chapter 6 and examines narrative writing, where people are asked to write their story, or elements of their story. Narrative writing is often used as therapeutic writing. For instance, expressive writing is a particular method of writing about a subject on a number of occasions. The writing is not analysed, it is thrown away. People may be asked to address a specific problem in a particular way or they may simply be asked to write about it. The evidence is variable, suggesting that the technique works for some people but perhaps not for others. Chapter 8 focuses on narrative therapy, a name given for a range of therapeutic approaches. The term may be employed loosely to describe any approach that encourages people to tell or restructure their story – at the extreme all talking therapy is narrative therapy because it is intended to help people make sense of their lives and the events in their lives. Narrative therapy has several components (White, 2004), such as examining the stories that shape a person’s identity, an externalising focus, whereby naming a problem can help a person see how it works and how to fix it, and a focus on unique outcomes (Goffman, 1961), which are central to a person transforming themselves through changing their life stories. Through narrative therapy, people identify their particular skills and abilities and use these to transform their life stories. Narrative therapy has been used in a range of situations such as eating disorders (Weber et al., 2007), domestic violence (Allen, 2007) and conflict resolution (Winslade & Monk, 2000). One important problem with narrative therapy is that it is a constructionist approach where there are no absolute truths, which might lead to a conflict between a person’s post-therapy narratives and the dominant cultural master narratives. This suggests a fragility of narratives whereby post-therapeutic experiences may undo any positive benefits. There are

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also few controlled trials examining the efficacy of narrative therapy, so the evidence base is weak. The next chapters examine narrative approaches in applied contexts. Chapter 9 focuses on NET, which has gained popularity over the last few years, has a growing evidence base and is now accepted as an effective clinical practice in a number of countries (e.g. NICE in the UK, APA in the USA) as a frontline treatment for PTSD. NET was introduced around 20 years ago as a treatment for traumatic stress, particularly in difficult to reach populations such as refugees and people in the developing world who have survived war, child abuse or severe human rights violations. It is a manualised treatment that can be employed quickly and by and for people with limited expertise in the field of trauma. The reason NET has become so popular since its introduction is that it draws on innate human attributes and good psychological theory. It is not a complex procedure and it is easily understood by those who are being treated with it – which is what gives it its advantages over other approaches. For example, if people understand an approach, they are more likely to engage with it – less likely to drop out. NET draws on our innate desire and need to construct narratives. It is about telling one’s life story to a receptive audience. People who are traumatised can have difficulty putting their experiences into words, the procedures of NET help them do so. After experiencing trauma, many people, though they do have difficulties verbalising their experiences without help, do want to bear witness to their experiences, to tell others and perhaps to gain some comfort for themselves or to see perpetrators punished for their behaviours. A good narrative enables a person to bear witness, and one outcome of NET is that the person has a signed account of their experiences that could be used as a witness statement in court. NET is built mainly around the critical importance of narrative and telling one’s story, but it also draws on good psychological theory about traumatic stress. The chapter will go into detail but fundamentally a negative response to trauma involves traumatic memories (so-called ‘hot’ memories in NET theory), which are difficult to control, have conditioned negative feelings and cognitions and cause a range of symptoms. NET focuses on addressing these hot memories in the context of the person’s lifeline (a series of the most positive and negative events in a person’s life), enabling the hot memories to lose their traumatic power and become part of the person’s life narrative. The chapter will examine this process in detail and the evidence relating to NET. The chapter demonstrates the benefits of using a narrative approach in therapy, and there is very good evidence for its effectiveness. NET is now

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Introduction

considered appropriate by NICE in the UK for the treatment of PTSD. People who are traumatised often have difficulty undergoing therapy as it can be a painful process. The dropout rates are often very high. This is alleviated by NET itself being a natural narrative storytelling process. It is not in itself difficult. The subject matter is painful, but the therapeutic process is a natural one, which means that the dropout rate is very low. Chapters 10 to 14 explore research in a specific range of areas, narrative medicine, narrative health psychology, narrative work psychology and narrative coaching. The research on narratives in these areas is relatively limited, but there is great potential for the future. The chapter will look at research evidence but will mainly focus on this potential. In health psychology, much of the research has focused on telling stories of illness (Sools et al., 2015) such as childhood cancer (Moore et al., 2015) and eating disorders (Papthomas et al., 2015) rather than in trying to make them deal more effectively with their illness, though – as noted earlier – just the act of telling a story can help someone feel better. There is not a specific chapter on narrative clinical psychology as this is sufficiently covered in specific chapters on NET and narrative therapy. There is relatively little research within occupational psychology on narrative. I have written about introducing narratives into the performance and appraisal system (Hunt, 2011), with a focus on how narratives function at different levels: individual, interpersonal (e.g. manager/worker relations) and organisational. Boudens (2005) used a narrative perspective to identify clusters of emotions associated with prototypical work situations, arguing that narratives were the best way to approach this topic. Scott (2019) explored how people make sense of their work, how they develop meanings using narratives. Narrative approaches are increasingly popular in coaching. The basic position is that people need to change or adapt negative narratives about their lives to substitute more positive ones. The most extensive account of narrative coaching is by Drake (2010, 2017), who discusses the importance of the narrator, their narrated stories and the narrative field. He recognises the instinctive nature of storytelling and how it is helpful in bringing about change. Chapter 14 draws conclusions about the narrative approach, what has been achieved and what can be achieved in the future. Unlike a lot of psychology, which focuses on the negative in an (often futile) attempt to make it positive, narrative psychology is inherently positive. It is what we all do; it is how we make sense of the world. This final chapter will look back on the book, how narratives have made a difference in psychology and the ways in which we can develop new narrative approaches throughout

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psychology. Narrative psychology, because it has come from the arts and social sciences, has suffered from being under the umbrella of postmodernism and social constructionism, and so has alienated many mainstream scientific psychologists. It is time that this changed. Narrative psychology is scientific psychology. It is based on good evidence about how the brain is structured and how the mind functions. It is what we do naturally and so it must be brought into mainstream psychology. The book will focus largely on areas of applied psychology, but throughout this will be based on the best science we have for the narrative approach.

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Chapter 2

What Is Narrative?

Narrative is rather a messy area. This chapter and the next two will try to make sense of it first in terms of what we mean by narrative, narrative psychology and narrative and culture. Narrative is messy partly because it is employed by a number of disciplines, which define the construct differently according to their own theories and methods. Disciplines use narrative for different purposes, so it is not surprising that there are areas of disagreement. This is not the place to examine all these areas of disagreement, as the purpose of the book is to enable psychologists to make practical use of narrative. I will largely ignore the applications of narrative in other disciplines except insofar as they are helpful to understanding narrative psychology. Anyone who wishes to have a linguistic, sociological, or other explanation of narrative should look elsewhere. We need a workable theory of narrative that can be applied in a consistent and useful manner. In this chapter, I will attempt to define narrative, examine the key concepts associated with narrative, explore some elements of differing theoretical perspectives across disciplines to show ways in which they are helpful for psychologists and outline the general theoretical perspective employed in this book. While there is much disparity between narrative approaches, as we have already seen, they do have common foundations. They centre on the narrative or story as a unique form of discourse.

Narrative and Story There is little consensus regarding the uses and meanings of the terms narrative and story. They are often used interchangeably. For the purposes of this book, as we are discussing narrative psychology, there is a clear distinction. A story is a specific tale that people tell. Narrative refers to the resources and skills that we have that are used to construct the story. 16

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Narrative is a series of biological, cultural and social resources that provide the means by which people can construct stories. We can discuss the narrative components that make up stories. Narratives are about temporality, coherence, plots and so on, and the result is the story. This distinction will not be acceptable to everyone but it has practical utility. Stories matter when we are discussing the application of narrative. It is through interpreting stories that we examine people’s mind and behaviour, sometimes through examining the effectiveness of their narrative processes, processes which can break down or fail under certain circumstances. Narratives and stories are important because without them language is just a sequence of sounds, little more useful than crude grunts and gestures were to the first homo sapiens. Our ability to make language meaningful is the work of storytelling, an ability that allows us to recognise and make meaningful patterns of words, phrases and inflections, to make and recognise common story forms and archetypes, and to be responsive to those patterns when they are communicated to us in fragments. Narrative itself can be split into two elements: first, the narrative skills and processes that we all have, the brain components that enable us to construct the second, the stories or narratives themselves. A story is a sequence of related events that are situated in the past and recounted for rhetorical/ ideological purposes. Events are composed of multiple elements, including actors, times and other entities which relate to one another through actions that occur. The term ‘story’ is often used in a colloquial sense to refer to a wide range of resources ranging from official and unofficial news stories to family stories to online postings and blogs. Stories can emanate from a variety of places and serve a variety of purposes; they all share a similar structural integrity: a sequence of related events situated in the past that is recounted for a rhetorical or ideological reason. Are narratives and stories the same thing? Stories are relatively unambiguous. We all know what a story is, a sequence of words describing series of structured events with characters, actions and so on. Narratives can be stories but narrative also refers to the skills we have in constructing stories. There are implications of narratives and stories not being the same thing. We all have our narrative skills, but there are individual differences in how effectively we can use them and we tell different stories of the same event. Two people may have a similar experience but the stories they tell may be very different. This is partly because of how they focus the story, what is important to them, what they remember and partly because of the audience they are aiming at. A story is not a perfect reflection of experience,

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What Is Narrative?

but an interpretation derived from not only what happened but also personal memories, interests, personality and so on. In psychology, the study of narrative skills is important. It is often assumed that we all have effective narrative skills, that we can all produce coherent stories about the world in which we live, but this is not necessarily so. People differ in their ability to use narrative skills. Some people have very good narrative skills and some have poor skills. This is why narrative therapy may not be suitable for everyone. The key question here is whether we can get those with less effective narrative skills to produce good narratives. Can we train narrative skills? Is this why we have creative writing courses? When psychologists are using narrative exposure therapy (NET, see Chapter 9), they are not relying particularly on the narrative skills of the client, but on the ability of the therapist to help the client construct the story. This might work for verbal forms of narrative, but can it work with narrative writing, where the therapist is not providing that level of guidance? This is not clear, as we shall see in Chapter 7, on narrative writing. In general usage, narrative and story are interchangeable, and this is in part due to the connotations of the words and the ways they are used in everyday speech and writing. These connotations are used throughout the book in order to be pragmatic and avoid awkwardness. This is an applied book, not a deep consideration of the finer points of narrative theory. In the end, someone who says they are describing a narrative are describing a story, and vice versa.

Characteristics of Narrative Narratives are characterised by sequence (temporality) and consequence (point, message; Reissman, 2008). Narratives also have characters, plot, space and genre (Randal, 2017). The ability to capture time means narratives are essential to human existence (Ricoeur, 1984). This will be explored further in Chapter 3, but without narratives, we would have only limited access to the past (as memories would have limited organisation) and possibly no meaningful access to the future. Without the past and the future, there is a limited or no sense of being human. Bruner (1991) proposed ten features of narrative, a list which is adapted below as twelve points. 1. Universal. All people use narrative for most of their thoughts and interactions with others. Narrative does not constrain interaction between people, language does. Narrative enables translation of one language into any other language.

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2. Temporal. Narrative is irreducibly durative. Time is essential to narrative. Without time, all we have is an event. 3. Generic. There are conventionalised representations, both of narrative itself and the forms of telling. Stories are told in particular ways and not other ways. It is from generic stories that we then develop into particular stories. 4. Intention. What happens with narrative in a social setting is relevant to people’s intentions. Social settings are affected by what people do in those settings; social settings derive from people’s stories. 5. Meaning. Narrative helps provide individual and social meanings for events. 6. Canonicality and breach. There are canonical scripts for situations (e.g. restaurant and classroom). For a story to be worth telling, this script must be breached in some way. 7. Referentiality. There is always reference to truth in narrative, both in factual accounts and in fiction. Both use reference to truth and so it can be difficult to differentiate truth from fiction. For truth, we rely on trust. 8. Normative. Narrative is essential normative because it relies on breaches of these norms for a story to be worth telling. This illustrates the importance of narrative as scaffolding for stories, providing the essential components of a story on which the actual wording of the story is based. 9. Context sensitivity. Stories are not just about individuals, they are about the context in which the individual exists. 10. Negotiability. It is usually possible to tell several different versions of the same story. There is socio-cultural negotiation which depends on the context and the people involved. 11. Accrual. Stories are grouped together and eventually become culture or history (as master narratives, see Chapter 4). 12. Audience. Without an audience, there is no story. Narrative requires participants. Sometimes, the audience may be the person creating or telling the story, but on most occasions, there is an audience or an intended audience or at least an imaginary intended audience. Wright (2002a) argues that there is an interplay between three terms, narrative, story and myth, with a preference for the word myth as the medium through which religion, neuroscience and mental well-being all interact. This illustrates the terminological difficulty we experience when studying

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narrative. As established, narrative consists of the set of rules and skills for creating stories, and so functions at a higher level than stories and myths, terms that are in many ways interchangeable as all stories are myths, they mostly contain some truth and some fiction, with a broad sweep of interpretation included. Shannon (2005) made a similar mistake, arguing that if rational explanations such as quantum physics and evolution are fully adequate explanations of our origins and realities, then why do we continue to read, create and reformulate myths? This is a misunderstanding of the nature of science. Quantum physics and evolution do not provide fully adequate explanations of anything, they are just the best stories we have at the moment. Science is narrative (Prickett, 2002). Indeed, according to Niels Bohr, and he should know, quantum theory is not telling us what is, but what we can say to each other. Presumably, at some point in the future, better stories will replace our current science stories. Personally, though without evidence, I am looking forward to the story that removes the story of the Big Bang, which is just another term for God in the sense that humans need to have a beginning. Genesis or the Big Bang? Both are interesting stories. Neither are good representations of the ‘truth’, whatever that means in this context. Humans have very limited cognition and require beginnings and ends, not only to our own stories, which always have beginnings and ends, whether formal, for example, novels, or informal, for example, describing what happened today, but also the stories of the universe. Discourse is, according to a Wittgensteinian approach, a rule-based manipulation of symbols in multi-person episodes that unfold in material settings, that is, human narrative capabilities, enable us to talk to each other in the real world and interpret that real world in different ways. This approach, central to this book, relies on the work of Wittgenstein, Vygotsky and Garfinkel, all of whom focused on the importance of the social in the development of the human mind; and to be social, we need narrative. Herman (2007) outlined five key concepts that inform narratological research. 1. Positioning, for example, powerful/powerless or admirable/ blameworthy people. We use position-assigning speech acts in our everyday speech. 2. Embodiment. This is a critical scientific position. Unlike during the first cognitive revolution, we accept that the mind is embodied, minds are a nexus of brain, body and environment. The mind is put on the same footing as the environment. This helps avoid making

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cognitive processes wholly explanatory of behaviour and ensures that narrative approaches are grounded in a scientific realist position. 3. The mind is distributed. Minds are in an essential way spread out among the participants in discourse, speech acts and objects in the environment. There is transindividual activity across participants and groups. 4. Emotion discourse and emotionology (Stearns & Stearns, 1985). There are collective emotional standards of a culture rather than the individual experience of emotion itself. 5. The problem of qualia. Qualia are qualitative experiential properties of mental states. Are they reducible to physical brain states or are they an unbridgeable explanatory gap between accounts of brain physiology and the phenomenology of conscious experience? Fludernik (1996) argues that experientiality or the impact of narrated situations on consciousness is a core property of narrative itself. The position here is that qualia are reducible to brain physiology but how it happens is as yet unknown. We continue to propagate myths because intrinsically humans love stories. They love stories that provide an explanation, any sort of explanation, even God, and stories that appear to provide an explanation, and stories that do not provide anything other than entertainment. We run our lives through stories, we love stories, we love making them up, telling them and listening to them. The story is often more important than any truth or falsehood behind it. Gottschall (2012) argued that ‘Religion is the ultimate expression of story’s dominion over our minds’ (p. 119). A little like Marx’s opium of the masses. We care less about truth than we do about a coherent explanation, which is why religion remains popular in a scientific enlightened world. Prickett (2002) argues that ‘we are concerned with models of reality – and such models are usually verbal and almost ­invariably ­narrative’ (p. 71).

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Chapter 3

Narratives in Psychology

Chapter 2 addressed narratives in general. This chapter focuses on the uses of narrative in psychology. There are several reasons why narrative is important in psychology. As we have seen, the use of narrative is universal among humans (excepting perhaps some people with severe mental health problems, but they are not the focus here) and it is surprising that psychologists in general have not focused more on this area. We use narrative in most things that we do. We tell stories about many aspects of our lives, most of our thoughts have some sort of narrative structure, our working lives are full of narratives, we use narratives when we go on holiday, when we talk to each other and when we are working out problems in our heads. Just as importantly we listen to other people’s narratives across all these situations and more. We learn through listening to or reading narratives, we read books, magazines and social media sites, we listen to our spouses, children and friends, we attend lectures, the theatre and the cinema. All are forms of listening to narrative. Narrative is central to our lives; we could not function without it. Along with the opposing thumb, narrative is at the heart of what it is to be human. We create narratives, we co-create narratives, we use narratives and we listen to narratives. The opposable thumb enables us to make and use complex tools. Narrative enables us to remember and understand the past, the present and the future, and enables us to control emotions and to have rationality. Rational thought is narrative thought. Bruner was wrong in differentiating paradigmatic and narrative psychology. Narrative is the root metaphor of all psychology. Every interpretation of behaviour, whether neuroscientific, cognitive, behavioural, psychodynamic, etc., is based on our ability to employ narrative skills. Sarbin (1986) also argues that narrative is the root metaphor for psychology. Central to his argument is that human life is inherently contextual, things happen to people at specific times in specific places. Sarbin argues that Bruner’s paradigmatic positivist science seeks general laws and is rather ill-suited for understanding human 22

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functioning. Narrative thinking builds explanations specifically relating to a particular context in which human intention is enacted, so is more readily applicable to understanding human functioning. As psychologists, we should be concerned with all aspects of narrative. Without narrative, we cannot do psychology. We should understand why we use narrative and how we use it. We should understand why it usually works and how it can fail. We need to know why someone with depression focuses on negative narratives about their lives while most of us focus on both positive and negative narratives. Why is the glass seen as half full or half empty? If we can understand why some people focus on negative narratives, then what can we do to help them be more positive in their stories? In my research, I have focused a lot on traumatic stress. Why do people who are traumatised have such difficulty describing what happened to them, often reverting to non-narrative forms of expression? What blocks narrative processes, those processes that enable us to build and tell a story, from functioning? Psychology has employed several theoretical approaches in order to understand human behaviour and the mind. These have been more or less useful depending on the problem addressed. Behavioural approaches and cognitive psychology have been particularly popular for many decades, and they have made useful insights into how the human mind works – or doesn’t work. What is surprising is that narrative has been largely ignored, at least until recent years, and it is still ignored by many psychologists even though it is the critical element of the human psyche, one that must be understood if we are to progress in psychological science. Indeed, much of what psychologists do and say is narrative in nature, if not in word. When we discuss memory, we may discuss how we are better able to remember items when they are built into a story rather than as a list. The whole theory around mnemonics is built around this simple fact. The concept of stress in the workplace is best explained using stories, exploring the causal reasons why people are stressed, how it relates to their experiences, coworkers, work activities and so on. We have to build a story to understand how stress works. It is the same for any theory in psychology. A theory is a story, an attempt to provide a coherent narrative about some aspect of the mind or behaviour. Narratives enable us to understand, to make sense of, what we see and hear around us. Narratives enable us to make sense of the environment. All psychologists study narrative, it is just that some may not be aware of it. While many animals are social, it is narrative that enables us to devise and develop culture. It is the ability to reflect back to the past

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and forward to the future that enables us to have and develop ideas about how we should live as individuals and together. Narrative gives us memory, the ability to think about previous behaviour, about our relationships and how they have developed and about society and culture. Memory enables us to think about the future and how previous behaviours impact on how we choose to behave in the future (not that all behaviour is about choice, much of it is instinctual, much of it is trying to avoid the instinctual). Narrative skills give us rationality and cognition. Without narrative, we are just emotional creatures of habit. Narrative content and narrative structure both promote flexible, adaptive functioning (Richert, 2006). Some researchers de-emphasise the role of causality in narrative simply because it uses qualitative approaches, though one of the critical aspects of narrative is temporality, that one thing precedes another, and that without a logical sequence of events, there can be no narrative. While this may be causal, and often is, different consequences may be derived from the same set of circumstances, with human intention playing a key role. This is the heart of the argument for free will, our ability to make choices given a fixed set of circumstances. Narrative explanations are never based on exact and precise recounting of all preceding events that might be relevant but instead are based on partial, often selective, recounting of all relevant preceding events. Another way of looking at this is that only narrative explanations provide causal explanations. With narratives, we are trying to find explanations. Rationality and logic are forms of narrative where we attempt to be more precise, but throughout science, whether we are considering the difficulties of understanding human action or the origins of the universe, it is very difficult to determine causality with precision, except in relatively simple circumstances. Part of our growing scientific understanding involves the recognition that our causal explanations are inadequate and that we need to replace them with ones that better fit the data. Even in science we have incomplete and biased explanations. Several authors have discussed the centrality of narrative to psychology. According to Schiff (2017), narratives should be central to psychology otherwise the subject is ‘in danger of being irrelevant to the understanding of persons and everyday experience’ (p. 4). Narrative provides a unifying theory and method that provide insight into ‘how persons, in context, interpret themselves, others and the world’ (p. 43). According to Sarbin (1986), we function via the narratory principle, that ‘human beings think, perceive, imagine, and make moral choices according to

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narrative structures’ (p. 8). Narrative brings order and meaning into our ever-changing world. We use it to constantly interpret, re-interpret and understand what is going on around us. We are born into a storyshaped world and experience life through this constant development and modification of stories. Creating stories helps provide a coherent and plausible account of how and why things happen (Polkinghorne, 1988). Bruner (1990) argues that narrative cognition is the organising principle of humans, rather than logic or scientific empiricism – we live in a world of possibilities rather than certainties. According to Bruner, without narrative schemas, we would be lost in a murky world of chaotic experience and may not have survived as a species. Our predisposition is to organise our experience into narrative. As narrative psychology is rightly concerned with the storied nature of human conduct, with people creating and telling stories and listening and responding to the stories of others, narrative should be the main root metaphor for psychology, not cognition, neuroscience or behaviourism, but narrative psychology. Life is more about meaning than it is about logic (though logic is a form of narrative). If we were as logical as the cognitive psychologists would have us believe, then there would not be so much trouble in the world and we would not be such emotional beings. It is narrative that helps us make sense of our emotions, meaning-making, not logical thought. The distinction made by psychologists over so many years between logical thought and emotion is a false distinction. We are driven by emotions, but we control them through meaning-making and stories, not by logic. We are more concerned with meaning and c­ oherence than logic.

Stories and Narrative Processes Psychologists should be interested in narrative in two ways: to examine stories and to examine the nature of narrative processes. Psychologists tend to focus on examining stories, their meanings and the ways in which they might change to have an impact on a person’s identity or roles. Narrative processes concern the nature of the underlying processes by which we can tell and understand stories. While there is a good understanding of the psychological nature of narrative processes, there have been only limited attempts to understand the underlying neuroscientific nature of narrative. This is in part because psychologists have shown little interest in narrative, and partly because narrative processes are complex and have complex neuroscientific bases. I will return to this later.

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Individual Differences If we are to study narrative, we need to acknowledge individual differences. We do not all have the same narrative skills; indeed some people have very limited narrative skills. These tend to be people with limited cognitive abilities generally. Our genes are likely to be important in understanding individual differences in narrative ability. People have inbuilt characteristics that affect the ways they develop narratives. There are personality characteristics that remain largely unchanged throughout life. People have varying levels of functional intelligence that remains largely unchanged throughout life. These factors will all have a huge impact on behaviour above and beyond narrative skills. There is relatively little research attempting to draw together the various aspects affecting behaviour, including narrative. In part, this is due to the politics of psychology; there has generally been a separation between mainstream psychologists and narrative psychologists. This is not only a problem with mainstream psychology, but also many narrative psychologists prefer not to become involved in mainstream research because they prefer not to acknowledge the importance of these key individual difference factors, for example, denying cognitive ability differences or the relative permanence of personality styles. There is an assumption among many psychologists that variation in human performance is about opportunity and environmental factors rather than intrinsic factors. This is a serious limitation not only of narrative psychology but also of psychology in general. It is a dangerous position to take as it fails to recognise genuine differences between people. I do not wish to go into the arguments around this, but the key point is that human functioning, while reliant on narrative processes to be human, is not just about narrative, it is about other individual characteristics. Together these factors help determine the nature of self and identity.

Psychology Is All about Narrative All psychology is narrative psychology. Psychology is the root metaphor of psychology. There is no psychology without narrative. At its core, this takes us to the nature of science itself which, no matter how many people might argue about it existing outside culture, its objectivity and so on, is still a narrative about understanding the world. The cosmologist attempting to understand the universe is not standing outside human understanding, outside human narratives. Our perceptions of the universe depend

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on our current understanding of the world, our current narratives. Key to this is one element critical to narrative, temporality, and with temporality, we want beginnings and ends. The cosmologists of the past, we called them theologians, understood the universe in terms of God. God created the universe and God will end the universe. The modern cosmologist has a different narrative. The universe started with the Big Bang, the universe will end with the Big Crunch or – depending on your point of view – the Big Blackout. The modern cosmologist/theologian has an explanation that is essentially the same as the ancient theologian/cosmologist. There is a universe that has a beginning and an end. It is just that they say there are different causes to the beginning and the end. In reality, God and the Big Bang are just different names for the same thing. They are alternative narratives with the same underlying structure. These explanations reflect not the increasing wisdom of the human race but the absolute necessity of the human race to provide a narrative explanation which includes causes, beginnings and ends. We are born, we die; we build a house, it eventually falls down. There is a beginning and an end to everything. That is about how the human mind works, not how the universe works. It demonstrates the narrative nature of the mind and also the limitations of the mind to fail to go beyond time, that key narrative concept. It demonstrates our cognitive limitations, our inability to think outside being human surviving on planet Earth. To pull back from the rarefied nature of the universe to more mundane psychological understanding, there are a number of key schools of thought in psychology, such as behaviourism, cognition, neuroscience, psychoanalysis and so on. These schools have developed and changed over time and have varying levels of respectability within the psychological community (the master narrative of psychology) and different points. The argument here is that they are all forms of narrative psychology. This is because science is narrative. Each is telling a story. The behaviourist tells the story of how variables relate together, how one behaviour causes another behaviour and how operant and classical conditioning function. Cognitive psychology has stories about memory, attention and perception. Psychoanalysis has stories about the id, the ego and the superego. Neuroscience has stories about how particular parts of the brain are linked to particular behaviours. These are all narratives and this is why all psychology is rooted in narrative psychology. In the end, all psychologists want to tell a story about the nature of human behaviour, the human mind and the human brain. As people with scientific narratives, we recognise the strength of these narratives and we recognise their limitations. We know behaviourism works. It

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has been applied to understanding and treating phobias, post-traumatic stress disorder (PTSD) and anxiety generally. We know cognition provides a good model for understanding the mind.

Narrative as Science This is not intended as review of the literature on narrative psychology, more an attempt to show that the range of narrative research, certainly theoretical narrative research, has been rather narrow and limited in its scope. Much narrative psychology research, at least outside of therapy, has, instead of examining psychological processes, limited itself to issues that are more sociological than psychological, for instance, race and sex, and interpreted story in terms of power rather than psychological process. The concept of narrative is linked to postmodern thinking, so many psychologists with a scientific bent might view it with doubt. This is unfortunate, and the scientific study of narrative is the basis of this book, narrative as science rather than narrative as morality or politics. As Laszlo et al. (2007) claim, the systematic linguistic analysis of narrative discourse may – I would say should – lead to a scientific study of identity construction. We need a method of narrative psychological content analysis, with programmes to identify compositional features in narrative texts and test the validity of these programmes with large-scale empirical studies.

From Cognition to Narrative The dominant paradigm within psychology for much of the post-war period has been cognition, with the mind as an information processing device, for instance, Chomsky’s theory regarding the language acquisition device, or Baddeley and Hitch on working memory. The first cognitive revolution was a reaction against behaviourism which suggests the mind is epiphenomenal, an explanatory fiction. According to Harre and Gillett (1994), the second cognitive revolution places the mind in material contexts of action and interaction without reducing mental activity to bodily activity. Cognitive narratology (Herman, 2007) explores the nexus between narrative and the mind. In discursive psychology, there is a theoretical distinction between cognitivist approaches where texts depict an externally given world and the discursive approach, which has an action orientation of talk and writing and is concerned with the nature of knowledge, cognition and a certain flexibility of human reality. Narrative serves as a series of resources for constructing one’s own as well as others’ minds.

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Evolution and Culture

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In the end, all models of human psychology are narrative models. They are all telling stories of how the mind is structured and how it works. These stories can then be subjected to testing and contribute to the further development of theory. At the basic level, cognitive processes relating to, for instance, language and memory exist to serve narrative processes. They are part of what it is to do narrative.

Narrative and Neuroscience In recent years, neuroscientific research on neuroplasticity and neurogenesis has completely transformed our understanding of the brain. If one area is damaged, then other areas can be retrained to do their tasks, brain cells appear and grow throughout life, rather than experiencing slow decay and death. Stories help the brain to negotiate the never-ending conflict between the need for pattern synthesis and constancy on one hand, and flexibility, adaptive ability and openness to change on the other (Armstrong, 2019). The key brain structure for narrative is the Default Mode Network (DMN), which is the circuitry or network of brain regions that is more active during passive tasks and used for remembering, thinking and mind wandering (Raichle et al., 2001). It is the brain’s most comprehensive network for the integration of information. It is also critical in enabling people to construct and tell stories and to create shared experience. The DMN includes, for example, the midline frontal and parietal structures, medial and lateral temporal lobes, the angular gyrus and the lateral parietal cortex. There is good lesion evidence for the function of these structures. For instance, lesion studies to medial temporal lobes lead to deficits in memory and the capacity to imagine possibilities that do not yet exist. DMN provides the infrastructure to reflect on the past, present and future and on the minds of other people (Mehl-Madrona & Mainguy, 2021). When emotional narratives are used, there are lingering after-effects described in the DMN, the amygdala and in sensory cortical areas. The precuneus appears to play a key role. Activity in this region seems to differ for real and fictional narratives (Jaaskelainen et al., 2020).

Evolution and Culture The basic proposition in evolution is that there is a mechanism of reduplication with transmittable variations and competitive selection of those that prove to have a better chance of survival. Evolution is a story unfolding

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in time with conditions, with scheme-like rules. In evolutionary terms, we initially had instinctual behaviours, we then developed emotions and then learned to control these emotions through what we like to think of as rationality or cognition, but is in actuality narrative processes. We will never really know how narrative emerged in humans, but there is speculation. Marschack (1972) argued for an agriculture-time-memorynarrative model, that the cognitive ability to narrate evolved under particular ecological and cultural pressures in the process of adapting to changing social conditions and the organisation of ethnic groups. The question of the development of the mental abilities needed for narrative justifies a scientific, biological evolutionary attitude from both phylogenetic and ontological points of view. Narrative is affected by space and time. Ricoeur (1984–1987) noted that the past, present and future are closely related to narrative ability. Heidegger (1971), using a hermeneutic approach, said that it is through narrative that we are able to bring past experiences or future events into the present and make them part of present experience. With time as key did narrative skills develop from a need to integrate and interpret past, present and future, and enable humans to move beyond an understanding of their immediate environment? Unfortunately, many people resist the integration of science and the humanities that is required to ensure progress in our understanding of narrative (Comer & Taggart, 2021). There has been an assumption that biological evolution in humans has somehow finished and we are now in a stage of cultural evolution. The reality is that we have evolved a wide range of behaviours that are functional and useful in evolutionary survival, from mother–infant bonding, reproductively differentiated sex differences, male and female cooperative groups, reciprocity, dominance hierarchies, internalised norms and the introjection of group identity into individual identity (see Chapter 4 on master narratives [Carroll, 2022]). We can argue that it is uniquely human – biologically evolved human – to produce fictional narratives and create symbolic images to imagine the world and the place of humans in the world. Cultures might combine these elements in different ways, use them in different ways, but underlying cultural differences, there are a wide range of human behaviours that are common to every culture, including the use of narrative. While some constructivists might reject evolutionary ideas, there are commonalities across all human cultures which suggest otherwise. The concept of cultural evolution, while appealing and suggesting that humans can fundamentally change their nature, is not such a powerful force as some might think. Nevertheless, understanding the role of culture and the social world is important.

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One fundamental evolutionary question is the relationship between language and thought. Bruner’s (1991) argument, building on Vygotsky, was that cultural products such as language mediate thought and place their stamp on our representations of reality. This in turn leads to what Brown, Collins and Duguid (1989) call ‘distributed intelligence’. Intelligence is rarely just about the individual, it depends on a network of friends, teachers, books, computers and so on. Research is needed regarding how we go about constructing the social world, that intrinsically narrative-based social world. The idea that language mediates thought is an important argument for narrative, it puts it at the centre of human abilities and psychology. According to Hegel, becoming or self-realisation is at the centre of human existence. We all want to have meaning in our lives, whether that is having an explanation for the universe, or understanding the point of our own existence (even if we conclude there is no point). Thinkers vary about what this entails. Atomists such as Pinker suggest that beliefs and desires are information incarnated as configurations of symbols, and that symbols are the physical states of matter, that is, the key level to developing understanding (Pinker, 1997). Atomistic thinking has the advantage that it lends itself to traditional scientific methods and attempts to build a picture from the ground up. Unfortunately for humans, it is not enough. We need to see the complete picture and analyse its components. According to holists such as Wittgenstein and Ryle, the major accomplishment of mind and language is rationality. This is not a biological but a social phenomenon. This distinction between the biological and social will keep appearing and is a somewhat artificial distinction, human culture does not exist without human biology, and so we need to understand both. Nevertheless, Rorty (2004) claims that explanations of human behaviour that tie it with neurology or with evolutionary biology will only tell us what we share with chimpanzees, not with those who painted pictures on the walls of caves or sailed the ships to Troy. Another limitation of the term ‘cultural evolution’ is that it implies some sort of progression. If we are to use cultural evolution at all, we should see a sense of cultures developing in a positive manner, somehow getting better over time, making mistakes and learning from them, using the principles of biological evolution and gradually improving. Instead, we see cultures or civilisations rise and fall, cycles of change, changing fashions, where any sense of improvement or ‘good’ is subjective and open to interpretation. It might be argued that the Enlightenment and perhaps the Industrial Revolution in the West have led to positive change. We can now think more freely in the West and we have technology which

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supports and apparently improves our lives. Yet these changes are neither objectively good nor permanent. The internet has provided us with a wonderful source of information but perhaps at the expense of cognitive abilities. People sit inside playing online games rather than going outside and kicking a football around or going for a walk. It might be argued we are changing for the worse. In terms of the Enlightenment, we have had several hundred years of increasing freedom of thought with awful periods of reaction such as the Inquisition or Hitler’s Germany, but this is constantly challenged. In the West, free thinking is being encroached upon, we are expected to have certain views about the world and reject others. The current culture wars or wokeism is a good example. We are constantly being told to think in certain ways rather than to think freely. For instance, we are expected to accept and respect Islam, a religion which resembles Christianity before the Reformation, a dangerous religion which often allows little free thinking (perhaps Islam is ready for its equivalent to the Protestant reformation). In the universities and elsewhere, we are expected to accommodate Ramadan and multiple daily prayers which interfere with student learning and assessment. Islamic beliefs are at odds with scientific endeavour, yet we are expected to have respect for them instead of challenging people who hold Islamic or other religious beliefs. We are constantly attacked by modern unenlightened crypto-fascists, who do not allow multiple views relating to a range of subjects, not only religion, such as transsexuality, race or sex/gender. These issues and others indicate that cultures do not evolve, they change, they do not always change for the better, and positive change is not always permanent. Cultural evolution is not evolution in the way it is understood in the scientific world. While Darwin may not have been happy with Spencer’s notion of the survival of the fittest, there is still a sense that evolution is, in the end, about positive change.

Dominant Narratives In Chapter 2, I briefly discussed the difference between story and narrative and the importance of narrative skills in human functioning. Here I focus more on what narratives mean for human existence and culture. We all have a series of narrative resources that we draw on to create our stories. These resources are biological, cultural and social. The stories themselves can have different foci. For instance, someone may say, ‘Yesterday I was well, today I am ill, but tomorrow I will be well again’. This is what Frank (2012) called a ‘medical restitution narrative’. It may be a dominant illness

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What Is Reality?

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narrative of the kind that some people have. Stories are not passive, they can do things and act on, in and for people. They can shape the beliefs, feelings and actions of those caught up in them, affecting lives positively or negatively, depending on our interpretation (Frank, 2010). This is a critical matter for psychologists. A person may focus on a depressive narrative, an anxious narrative or a lonely narrative, and they may benefit from help in changing those narratives. These narratives are dominant narratives. While some are positive, many have negative effects as they dominate people’s lives. A well-balanced person will use a range of narratives in accordance with the people they interact with and the cultural master narratives in society (see Chapter 4). People with a negative dominant narrative may experience problems adjusting to their social or cultural situation. This happens with all of us at times. We become out of step with what is happening. We worry about something and we cannot stop worrying even though we are out socialising with friends. It is not usually a problem if it happens occasionally, but there are some people who have a single dominant narrative that they use most of the time. We (as individuals, friends, family and psychologists) can challenge these narratives (Nelson, 2001), we can challenge a person’s central dominant narrative by telling and living counter narratives. There are other characteristics of the way we use narratives. The resources we have (the various narrative skills and abilities) are usually stable, but our personal stories can change over time. This can be changing from a dominant depressive narrative to a dominant contented narrative, or it may be more general aspects of our life stories, our biographies. For instance, narrative resources may be affected by physiological or psychological trauma. Our stories may appear to be derived culturally or socially (see Chapter 4 for details), they are also biological, they are embodied. Our stories are told with our bodies. We feel the stories, we use not only our voices but also our hands and eyes to tell stories; we communicate with ‘gut feelings’.

What Is Reality? Rather than a sense of objective reality, narrative theorists argue that – for humans – there is a genuine sense that reality is constructed. According to Sonnenschein and Lindgren (2020), reality is rendered conceivable by language that constructs the world not as it is, but as retrospectively interpreted and imagined in terms of future goals. This is critical to the nature of reality. Narrative psychologists do not deny the structure of the world, they are not pure social constructionists, but they recognise that we, as

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human beings, can only understand the world in terms of the narratives we create about it. This has been called critical realism, but that term implies a logic to the way we understand and interpret the world that is not always the case. The reality we usually experience is messy, undisciplined, unfocused and with unclear purpose. This is the nature of many of the narratives we employ. The critical element is absent from much of what we do and think.

Self and Identity We can draw a distinction between self and identity. The self is the relatively unchanging permanent element that provides continuity in our lives. I am the same person I was several decades ago. There are characteristics that do not change, irrespective of the environment in which I live and the relationships I have with other people. Identity, on the other hand, is changeable. Identity changes through narrative construction and reconstruction. It changes when we get a new job or change our relationships. It changes when we redefine elements of ourselves. Erikson (1968) defined identity as an integration of conscious and unconscious experiences which arise in interactions with the social world. It changes with age and changing environments. If we did not have the ability to change our identities, then there would be little point in studying narrative as an applied element of psychology.

Narrative Identity Narrative is central to the formation of personal (and social) identity (McAdams, 1996). Narrative identity is the internalised and evolving life story, which integrates the reconstructed past and imagined future to provide our lives with an element of unity and purpose (McAdams & McLean, 2013). As I will discuss later, narrative identity relies on culturally available narratives, narratives that we share. As there is a purpose to our narratives, there is intentionality and hence an ethical dimension. We can choose the structure of our narratives and the impact they have on behaviour. Sarbin (1986) called this the narratory principle, that humans think, perceive, imagine and make moral choices according to narrative structures. There is a case for reimagining James’ (1890) distinction between I and me. I is the author and me is the actor of the narrative. In this metaphor of self, the person’s agency (I) is revealed in the authorship process, it is the person who narrates (me) the life that is lived (and performed as an actor).

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Redemption and Contamination

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Identity can change. While there is a strong element of unity regarding the self, we see ourselves in many ways as the same throughout life; we do change. There is an evolving nature of identity; it is a progressive process (Singer, 2004). From a developmental perspective, this helps us to gradually develop the abilities to narrate stories about the self in culture – so narrative plays a critical role in child development. Reischer’s (2021) study of narrative identity has provided a rich conceptualisation of adult personality and important insights about the storied nature of meaning-making, particularly in younger and middle-aged people. Older adults may have phenomenologically different experience of autobiographical authorship than younger adults, for example, a traumatic breakup of relationship in youth is looked back on fondly. It is worth testing for age-related differences in narrative identity. Perceptions of normative behaviour change over time, and this may affect one’s narrative, for example, a ‘career woman’ in the 1980s is just a woman with a job now. A young man may be a seducer, whereas an older one lecherous. Social norms influence behaviour, so we need an understanding of how these norms can differ across the lifespan. According to McAdams (2015; McAdams & Pals, 2006), a person’s narrative identity is one of three layers of personality alongside dispositional traits (e.g. The Big Five) and characteristic adaptations (i.e. a person’s distinct set of values, goals and motivations as an agent). For Bruner (1986), narratives are not just stories, they involve intentional agents pursuing valued goals over time. Narrative identity is an implicitly held and explicitly told story of how someone came to be the person they are, including their triumphs, failures, dreams and regrets.

Redemption and Contamination Redemption and contamination are important concepts in narrative psychology that Dan McAdams and others have discussed in detail. They are particularly important when we are talking about transitions and the way people deal with transition. For instance, when someone is traumatised by a terrible incident, how they respond over time can affect their general health and well-being. This isn’t the place to go into details about PTSD (see Chapter 8), but redemption and contamination are useful explanatory concepts for the way we deal with traumatic stress and difficult times in life generally. Dan McAdams is a US psychologist, and the concepts of redemption and contamination can come across as quite culturally bound to the US

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way of thinking (the US master narrative of psychology), but they still have relevance elsewhere, though it is not necessarily the dominant script in the UK and elsewhere. This is an example of the difficulty of developing universal psychological theories. If they are problematic between such relatively similar cultures as the USA and the UK, which have broadly similar cultures and a similar language, there may be serious difficulties where the cultures are very different. This does not clash with the idea that humans are biologically very similar. It just shows that cultures can be quite different, and they can have a major impact on behaviour. Redemption is a useful mechanism for helping someone cope with their problems. Recuperation is the gradual lessening of symptoms over time and the ability to cope with any lasting emotional and physical scars. Redemption involves actively exploring our experiences and making sense of them, tying them into new narratives that incorporate the negative or traumatic experiences. According to McAdams (2006), redemption for people in the USA involves initially learning a series of positive values by which one should live. As one progresses through life, bad things happen, but these may lead to positive outcomes (redemption of suffering). Redemption occurs through atonement, recovery, emancipation, enlightenment, basically through growth and progress, hopefully with a happy ending. This has similarities to religious redemption, ideas that Europeans as a whole tend to be negative about. Nevertheless, the idea of redemption, that one can learn from negative experiences, is a universal one, one that is linked to the development of life stories or narratives. Redemption is a coping mechanism (Breen & McLean, 2017). On the other hand, while redemption is about moving from a negative position to a positive one, contamination is about moving from a generally positive position to a negative position. The good is spoiled by what happens and the interpretation of the outcome is negative. Again, this has importance for the development of the life story. Together, redemption and contamination can help explain at least part of why some people look on life in a positive way (using redemption) and some have a more negative point of view (contamination). This is a little like the dominant narratives discussed earlier. The aversion of many Europeans to such ideas relates more to these ideas being related to heaven and hell, eternal bliss versus eternal damnation; religious ideas rejected by most people in Europe over the last few centuries because of Enlightenment ideas that have significantly changed the way we think about the world (and has contributed to the difficulties of modern multiculturalism, see pages 54–57).

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Memory Construction

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What these ideas do tell us is that the way we interpret our lives significantly affects the narratives by which we live, either through a contaminated or a redemptive narrative, or – as it probably is for most people, a little of both. The conflict between redemption and contamination may be a helpful mechanism through which we resolve life conflicts, the way we develop meaning in our life stories. The whole notion of traumatic stress is that one’s life story is shattered by the experience. A person may have positive beliefs about the world, about other people, about themselves, but a traumatic experience can shatter these beliefs (Janoff-Bulman, 2010). Our ideas about a benevolent world, one that is meaningful and positive, can be broken. From this, there is a need to find meaning from these negative events through the resolution of conflict (McLean & Thorne, 2003; Thorne et al., 2004) and on to effective meaningful narratives that account for the new information we have about the world. We have to reconcile the present with pre-trauma identity (Park, 2010). The reconciliation of narrative identity is shaped by cultural scripts that detail the most adaptive and socially acceptable means to draw meaning from trauma (Adler & Poulin, 2009), the master narratives we consider in Chapter 5.

Memory Construction Many years of research on memory has established that most memories, apart from simple memories, are constructed rather than accurate representations of the past. Pleh (2020) argued that constructive memory processes are not the exception but the rule. Bartlett (1932) used stories and folk tales to support his constructionist theory. His most famous story, ‘War of the Ghosts’, was a narrative account of a battle that breaks many of the rules regarding narratives in the West. It is a Native American account. Bartlett found that when people attempted to remember the story, they reworded it to make more sense, that is, so that the memory conformed to their own narrative. Whereas early memory research – with the notable exception of Bartlett – focused on remembering simple information, strings of numbers or individual words, there is now a much stronger linguistic and structural emphasis. It has been repeatedly demonstrated that Bartlett, writing all those years ago, was right. Our narratives (or in Bartlett’s term, schemata) provide key anchor points for remembering information. This suggests that elementary sociality is a basic, rather than a constructed, feature of the human mind. Memory is not just about remembering the past. It has

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a purpose. It is about remembering what has happened so that we can use that information constructively in the future. We should be studying the function of remembering rather than, for example, recall errors. Bartlett treated the mind as active and so was an early constructionist. If he was working now, he might describe himself as a narrative psychologist.

Meaning and Narrative Lazslo et al. (2007) see narrative as a fundamental tool for constructing meaning, a way of organising experience rather than mere knowledge construction. We should expand the horizons of scientific psychology and look at meaning patterns through history and cultural change. We need to access historical narratives, working like archaeologists when examining older narratives to understand cultural psychology and evolution. Life narratives may be conceived as an outcome of dialogical process of negotiation, tension, disagreement, alliance, etc. between difference voices/perspectives of self (Goncalves et al., 2009). People are authors narrating their own stories, so narratives of life are multifaceted and multivocal. Hermans’ (2002) distinction between author and actor means that the person’s self is a multitude of authors (or I positions) narrating their stories while enacting as actors (me position) these different positions. Each voice or I position can tell a story from its own perspective, this transforms the self into a space of potentiality where meaning is constructed and reconstructed as different positions gain or lose power. There are limits to this argument, we see ourselves as primarily coherent selves, acting different roles in different situations – Goffmanesque actors with many masks. There is some choice to the life stories we use but it doesn’t generally change the underlying self. Alternatively the self changes very slowly. Perhaps we can just change the perspective within a given social situation; we can learn to behave more appropriately in a situation, without changing the underlying self.

Narrative Psychology and Complexity Narrative may present straightforward explanations and ways of doing things but it is intellectually complex. According to Laszlo et al. (2007), narrative psychology is an attempt to handle phenomenal complexity in the psychological domain, complex psychological phenomena such as thinking or personality. Group processes are embodied culturally and also in an evolutionary sense in narrative, therefore scientific narrative psychology,

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Universal and Constructed Narratives

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when striving for cultural and evolutionary explanations, must reject both atomistic and holistic approaches – instead narrative represents a phenomenal level where only patterns are meaningful, for example, the nature of identity or memory. Integration is represented by the life story, it has continuity, security and integrity. Knowledge of these does not predict behaviour, just ways of adaptation, which can be evaluated against the background of social environment and culture. These contents create the life story, which is amenable to scientific study (Lazslo et al., 2007). The life story with continuity, security and integrity is that of a healthy person. The problems occur when this life story breaks down, when it lacks continuity, security or integrity. This is where the applied narrative psychologist comes in, to help rebuild or reconstruct the life story, a relatively simply structured task, though often not simple to achieve, within the complex field of narrative.

Universal and Constructed Narratives We have touched on whether narratives are universal or whether they are constructed. By now the reader will be aware that the approach taken here is that it is both. Narrative processes are universal in humans, but we must also be concerned about how these processes are employed across different cultures, how we use our narrative abilities to create stories about the world. Fundamentally, the universality of narrative is that we all use it. The question is which of our narratives, if any, are universal. People in all cultures across the world use narrative, so there is no question that the fundamentals of constructing narratives are the same for everyone. As we have seen, neuroscientific evidence also supports this idea. Narrative is embodied. While narrative processes are universal, are there stories that people across all cultures will agree on? The key element here is how the body impacts on the development of narratives. An example of this is the work of Schachter and Singer (1962) on emotion. They argue that emotions consist of a combination of physiological arousal and cognitive interpretation. From this perspective, all humans have similar physiological arousal, but it is possible that the cognitive interpretations of this arousal are interpreted culturally, that is, using different narratives. This interaction between the universal and constructed narratives is important to understand. The second key question is an examination of how narratives are constructed and the kinds of narratives that people have. We want to understand the narratives that people create, adapt and use, and how these affect the relationships between people.

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Conclusion Narrative is the root metaphor for psychology. Our lives are built around narrative, and if we want to understand human behaviour, we must employ a narrative perspective. Other approaches can add to understanding, but in the end, we must build and understand human narrative and human stories. Richert (2006) noted that several authors have argued for sweeping changes to the ways we think about psychology. Looking for the perspective of therapy, he argued that there are four assumptions implicit in narrative psychology that are important to general psychological understanding. These assumptions apply not only to therapy but to psychology generally. 1) Although a first-order reality probably exists and constrains our constructions, it is not directly knowable, so people live in terms of a ‘second-order’ reality (Watzlawick, 1996). This is in the critical constructivist tradition and needs tweaking for narrative science. All behaviour can be understood at the neurological level, but for psychologists, it is essential to draw on narrative skills as the first-order reality. 2) Second-order reality is constructed through the process of ­telling ­stories, that is, it is narrative in structure. We make sense out of ­living by developing stories that order events through time and within delimited contexts to show how the current situation is ­plausible. We live in and through our stories (White & Epston, 1990). 3) Different people generate different stories and therefore different realities in which they live. This is most apparent in people’s situation-specific stories with their unique ways of construing and dealing with challenges and the constraints of a common culture (e.g. perceiving the glass as half full or half empty). Richert’s different realities are different interpretations of reality. Narratives do not create different realities; this is where the social constructionists get it wrong. We interpret reality, we do not create it. 4) Specifically relating to therapy, people have difficulties with living, they have problems that are effectively ‘broken stories’ (Howard, 1991; Monk, 1997; Neimayer & Raskin, 2000). Most of what we do in applied psychology, whether it is psychotherapy, occupational and organisational psychology, forensic psychology, is about ­broken stories, the broken stories of individuals, groups and society as a whole.

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Conclusion

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Narrative psychology has a lot of potential. Up to now it has mostly been the province of minority groups within psychology, mostly away from the mainstream. As this chapter has hopefully made clear, narrative psychology needs to become mainstream. We are all story constructers, story tellers and listeners, and this is central to much of our behaviour. We cannot move towards good general theories of human behaviour without drawing on the narrative perspective.

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Chapter 4

Master Narratives

Culture is a tool produced by mankind to evolve its own mind.

Vygotsky

The important thing is not what society has done with us, but what we do with what it has done to us.

Sartre

The term ‘master narrative’ has been used in many and inconsistent ways over the years (McLean & Syed, 2016), it is used particularly in the USA, but it is a useful universal concept. The purpose of this chapter is not to go into historical differences among definitions, but to find practical ways in which the construct of master narrative can be used. There are two key points to be made about master narratives. First, they are overarching, functioning at a level above that of personal narratives (which leaves scope for considering master narratives at sub-cultural levels). Second, they are, in a way, compulsory, that is, people within a master narrative must make use of them, both explicitly and implicitly. Master narratives provide a storied language that we internalise and reproduce to maintain a particular social order. Of course, this is not the whole story, and much of the interesting theory and practice surrounding master narratives is where people subvert them, ignore them and change them. In practice, while we are beholden to the master narratives within which we live, we do have the ability and freedom to fight against them or ignore them. Nevertheless, for most people, most of the time the master narrative strongly guides behaviour. Master narratives provide the social structures and rules which enable people to live together in relative harmony. Without master narratives, we would have no society, no ability to get on with each other. Narrative is a critical tool for organising thought. Experiences develop in a cultural context, these narratives define individual experience (Fivush et al., 2019, p. 157). Master narratives exist to define culture, resolve conflict and ensure peaceful co-existence among members of a society. They also, in many 42

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societies, dispute culture, create conflict and ensure there is no peaceful co-existence among members of society. In some ideal world, the master narrative will define what is ‘good’ and what is ‘bad’, how to behave and how not to behave and we will all live happily ever after. Master narratives are very powerful. They do dictate the way we behave, from which side of the road we drive on, to what words are unacceptable in polite society, to accepted (and contested) history, to the nature of literature, the freedoms and constraints within society and everything from formal laws to informal norms and values. Master narratives are an essential part of who we are. Master narratives are those narratives that are shared by many or most people within a society or culture. They are the cultural scripts or dominant discourse by which we live (Hammack, 2009). These dominant scripts can be identified in cultural discourses such as the media, literature and law. They contain collective storylines that can include anything from the history of a society to ideas about what it means to inhabit a particular social category or class (Hammack, 2010). They are about events (history) and groups (social identities). McLean and Syed (2016) provide a slightly different, slightly less controlling definition of master narratives, suggesting that they are culturally shared stories about a particular culture that provide guidance for how to be a ‘good’ member of that culture or society. This appears to be less constraining than the definition provided by Hammack in that it includes the element of choice, though how much that is the case when the master narrative is internalised and inevitably guides behaviour without conscious thought is not clear, possibly not operationalisable. McLean and Syed (2016) do provide some clear guidelines regarding how and why we internalise master narratives and how they are useful, universal and rigid. Master narratives are rarely or never shared by everyone, as there are people who will not agree with the narrative. Master narratives can be dominant, where they are shared by the vast majority, or they can be conflicting, where there are two or more conflict narratives held within a society at any one time. One of the purposes of a master narrative is to explain the stories that exist at a lower level, for example, the individual or interpersonal. It might be easier to use the analogy of sports. The master narrative is the set of cricket rules and expected forms of behaviour, and the individual lowerlevel narratives include particular matches and the behaviour of the players. In other words, master narratives create conceptual models that bring the lower-level stories together, they order and explain knowledge and experience. They are coherent systems of interrelated and organised stories

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which share a common desire to establish and meet the expectations of people who live with those master narratives. It is too simplistic to say that there are two levels of narrative, the individual and the master. There are numerous levels which are difficult to classify. There are narratives that are mainly personal, though as we have seen these often have interpersonal elements. There are narratives that are interpersonal or joint, for instance, many people comment on how long-married people communicate in what appears to others to be a form of shorthand; they share a joint narrative. There are narratives that are interpersonal among a group of friends or colleagues that work in a similar way. There are narratives that are common to classes of people, such as the ways miners or builders or bankers communicate, and then there are the society-wide narratives, the genuine master narratives, which while they may not be shared by everyone within the society, they are commonly shared. The higher up the hierarchy of narratives, the fewer the number of narratives. At the highest level, there are narratives that are shared by all or nearly all members of society. These are based on knowledge of history, the philosophical positioning of a society, education and so on. Sharing a language is one of the base components of a societal master narrative, and without that it is not possible to have a cogent joint master narrative. As Weber et al. (2007) suggested, master narratives define the principles of a particular social order, which cannot just appear out of nowhere. It is constructed and shaped by the people within society as they interact and communicate, arguing which behaviours and ways of relating to one another are preferable to others. In this way, master narratives evolve. There are other terms for the master narrative. These include canonical narratives (Bruner, 1990), dominant cultural narratives (Andrews, 2004) or hegemonic tales (Ewick & Silbey, 1995). Master narratives provide guidance about how to be a good member of a culture (McLean & Syed, 2016). They are the blueprint for all stories, how we understand ourselves and others (Hochman & Specot-Mersel, 2020). The implicit nature of master narratives both makes it difficult to study them scientifically but also makes them powerful in examining how people construct their worlds. They are invisible yet appear quite natural, ensuring the status quo. A master narrative within an oppressive regime ensures that the people remain oppressed and behave as they are expected to behave. They rely on most people not wanting to upset the apple cart, not wanting to cause trouble. One danger for researchers is that we can unwittingly collude in this process by reifying social categories by taking them for granted, and through this undermining possibilities for social change (e.g. Haslam & Reicher, 2012).

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Psychology and the Master Narrative

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Bruner argues that culture is itself narrative. Culture has an essential role to play as the glue that keeps human societies together and functioning, a necessary means of survival, and narratives provide common themes that we use to interact with. Symbolic systems exist to enable us to construct meaning. As Shore (1996) puts it, epistemogenesis is a collection of culturally regulated processes of socialisation and self-development by which our knowledge becomes consciously available through language – rather than a developing objective knowledge of the world. We could go further and say that we only have culture because we have narrative. Narrative underlies the development and expression of culture. Master narratives are those narratives that are shared by many or most people within a society or culture. They are rarely or never shared by everyone, as there are people who will not agree with the narrative, who have their own master narratives, subcultures or ways of living that are in some way outside the norm. Master narratives can be dominant, where they are shared by the vast majority, or they can be conflicting, where there are two or more conflicting master narratives held within a society at any one time. For example, Brexit in the UK, with the country evenly split at the time of the referendum in 2016 between wanting to stay in the EU and wanting to leave (hardly a democratic mandate for leaving, but that is an argument for elsewhere). In the years before the referendum, there was a growing narrative supporting leave. At the time of writing (2023), it appears there is a growing narrative supporting rejoining the European Union, showing how the influence and power of a master narrative change over time, in relation to several factors such as the influence of the media, the economy and individual personal narratives. This is a good example of how conflicting master narratives can cause serious problems within a society, which may play out in several ways over the long term, the most serious being civil war – though hopefully that won’t happen over Brexit, the levels of anger – on both sides – were and are extreme, demonstrating the utter incompatibility of some conflicting master narratives, and the danger such conflicting narratives can have in society.

Psychology and the Master Narrative Master narratives are not just about grand narratives that exist across the whole of a nation or society, they can occur within a particular field or discipline. For instance, within psychology, there is a master narrative that the medical model of mental illness is the best model to use to help people who have mental health problems. There is, though, a significant

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group of practitioners who reject the medical model approach and want to explain mental illness in other ways – often rejecting the term mental illness itself. Sometimes the conflict between master narratives can be productive, leading to positive change, for example, the development of theory or practice. At other times, the conflict appears irresolvable, with two or more groups working differently but in parallel, often using different terminology, practices and theory, finding it difficult to persuade and compare with each other because they are using fundamentally different languages to describe similar phenomena. This is where narrative explanations come into their own. One of the problems with the science of psychology is that it is culturally bound. For instance, on the continents of Europe and North America, psychoanalysis and its offshoots have been relatively important, whereas in the UK, they are very much outside the mainstream. Another problem is that it is often difficult doing social psychology across cultures as people in different societies do not have the same ways of behaving. A key question in social psychology is about understanding which elements of behaviour are universal and which are cultural. Even between two apparently similar societies with apparently similar cultures and – supposedly – the same language, such as the UK and the USA, there are many differences. While the general joke is that we are two nations divided by a common language, there is a lot of truth in the differences, and it is not just the language, it is the norms of society, the ways we behave, the general philosophy of life, everything from gun culture to notions of religion. While many of these differences are superficial, there are key critical differences regarding the way we think. For instance, the influence of religion in the USA can mean that morality is more explicit, or the idea of individualism in the USA is much stronger than in the UK, the latter may be why we have the National Health Service in the UK and there is nothing similar in the USA. These are key elements of the master narrative that is dominant in a particular country. In much of psychology, we have assumed that findings from the USA translate easily to the UK. As we shall see in Chapter 6 – Life Interviews with the work of Dan McAdams, this is not always the case. As applied psychologists, why should we focus on master narratives? It is because individual narratives make no sense without master narratives. We are story tellers that rely on the social and cultural world to create our stories. Master narratives help us answer key questions such as how we make sense of events around us, how we integrate new information into existing information, how we provide justifications for what we do and

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Difficulties for Science

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perhaps even how we manage our general aims and ambitions in life, even how we construct and tell our stories. We can’t do anything we like; we have to work within the constraints of the master narrative. The master narrative might be flexible; we have the free will to ignore it, but usually we don’t. Behaving within the master narrative is generally implicit. It takes an active will to work against the master narrative. The master narrative has both formal and informal elements. The formal elements consist of rules and laws, that we do not kill people, or we drive on a particular side of the road. The informal elements are more flexible but are still constraining. Examples might include good manners, how and when we speak to other people and what it is acceptable to say or not to say. The informal elements also include how we think about the world. In Europe, we are generally liberal-minded, secular people who often reject or at least ignore organised religion (though see below relating to religion and the problems of multiculturalism or the clash of master narratives). Polkinghorne (1988) noted that personal stories are always some version of the general cultural store of stories regarding how life proceeds. McAdams (2001) added to this by saying that stories live in culture, they live according to the normal rules and traditions in society. When we are telling a story, there is an implicit understanding of what can and cannot be in a tellable story. Master narratives regulate not only what can be told but also how, why and when (Ewick & Sibley, 1995). Narrative is a critical tool for organising thought. Our experiences develop in a cultural context; these narratives define individual experience (Fivush et al., 2019). For these reasons, psychological theory must incorporate ideas from the master narrative to make sense. We are not individuals; we are part of a social world.

Difficulties for Science Science requires clear definitions and common methods (science is a master narrative in its own right). This can create difficulties. While at one level, it is obvious what a master narrative is, when an attempt is made to clearly define the term, then we run into difficulties. Does a master narrative have to be common to all people in a society? No, we have already seen that doesn’t happen. What degree of disagreement can be acceptable within a master narrative? I don’t know. It probably varies according to circumstances. Not everyone will agree with all elements of the master narrative (not that we really know what those elements are). Individual differences are critical in a functioning society. We all have our slightly

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differing personal narratives, which form the basis for interesting disagreements in society, but what are the implications for master narratives? Part of the problem is that they are used in different ways. McLean and Syed (2016) distinguished between three types of master narrative: biographical (cultural life scripts about how life should unfold), structural (how stories should be structured) and episodic (concerned with given past events). The other problem is how we study master narratives. This is going to be difficult if we don’t have an agreed definition, but master narratives are usually studied top down. Bamberg (2004b) examined US master narratives of masculinity reproduced in adolescents. Hammack (2006) examined polarised Israeli and Palestinian master narratives. Both of these assume a certain master narrative and then look at how it influences personal narratives. Perhaps we should think about how we can study commonalities between people from the bottom up. Ask people what they share, how they agree and disagree and develop the structure of the master narrative in this way. It is a method that is likely to generate stronger findings than the top-down approach, which assumes that the researcher has some a priori idea of the master narrative.

What Is a Master Narrative? According to Halverston et al. (2011), a master narrative is a transhistorical narrative that is deeply embedded in a particular culture. Master narratives do not just appear, they grow and change over time, they are repeated and gradually attain a key status within a particular culture. They are constantly changing and evolving, and we as individuals are greatly influenced by them. They dictate the ways we think and the ways we interact with one another. Culture is an ill-defined term, but will be taken to mean an inter-related set of shared characteristics claimed by a particular group (e.g. ethnic, national, social) of people. In the end, culture is a collection of stories that are passed between generations, changing all the time, but generally in an evolving rather than revolutionary manner. Master narratives help determine the nature of the narratives that we use with each other. These narratives range from reflecting simple interpersonal interactions such as the rules regarding how we speak to each other (e.g. good manners and how we dress) through to major philosophical concepts around what we mean by good and evil, the nature of religion and so on. The stories we use within the context of master narratives provide a sense of coherence, an understanding of the shared past and a set of principles for future behaviour.

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Myths

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Myths A key element of master narratives is that of the archetype, the typical character within our stories. The archetype can be a hero figure, a hate figure or any other form of typical character that is used within our stories. These archetypes can, according to Campbell (2018) with his notion of mythic narratives and the universal myth, help to inspire, direct and inform every aspect of our lives. Campbell’s mythic narratives are fundamental historical artefacts that are so deeply embedded in culture that they cannot be separated from it. They determine our understanding of who we are and how we behave with other people. Vladimir Propp (1928/1958) realised that strict rules or regularities are hidden behind the fantasy rich world of European folktale heritage. They perform a limited number of roles and functions. Colby (1973), exploring Eskimo folktales, found a generative grammar and developed a theory for the role of stories in culture. From repeated patterns, we extract schemata and templates, including the story template, and use these in turn to interpret new events. Cultural models are patterned and ready-made in a coded condensed form, that is, myths and folklore are forms or parts of the master narrative. Religion can play a key mythical part in the master narrative. It can dictate how we live our lives and provide a purpose for otherwise meaningless lives. As Marx would have it, religion can be the opium of the people, a drug to ensure that people behave appropriately, that is, a master narrative in itself. The Catholic master narrative in Europe was the dominant. This was the dominant narrative until the fifteenth century, when it began to lose its influence with the rise of Protestantism and liberalism, the Reformation and eventually the Enlightenment, with new ideas where religion is seen as irrational, and religious practice becomes confined to individuals and the private sphere, rather than dominating society. Religion lost much of its role in the master narrative across much of Europe, enabling civilisation to progress in ways that were impossible under the strictures of Catholicism. This separation of church and state across Europe (including in the UK, though formally there is no separation) depoliticised religion, and it lost its key role. Europe, particularly Northern and Western Europe, moved from being a religious Catholic society through the reformation and liberalisation to Protestantism, and religion moving from being the dominant master narrative of society to play a more minor role. One of the problems we are currently facing is the rise of illiberal Islam in Europe (many Moslems are liberal) and elsewhere which has many of the characteristics of pre-reformation Catholicism, with its strict rules about behaviour, dress

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and punishments for disobeying those rules. It is very different to Muslim Spain where Islam was at times the liberal religion, not in the modern sense but certainly providing some freedoms for other religions along with promoting knowledge. There is a danger here, with the master narrative of enlightenment Europe clashing with the illiberal constraints of Islam, which causes problems not only in Europe but also in Islamic societies which are clamouring for a more liberal approach. In terms of the master narrative, and an examination of how they can change across the years, perhaps it is time that Islam found its own Martin Luther, who might liberalise the religion and make it more acceptable to the modern world.

Identity Narrative identity is both personal and cultural, individuals follow scripts that constrain agency by privileging certain types of stories (Hammack, 2008; McLean & Syed, 2016). Identity is a psychosocial construction and master narratives are the main conceptual framework for describing the influence of culture on personal stories. According to Hammack (2008), identity development forms the link between self and society and the content is inherently political and ideological. Meaning arises through fusing personal and collective historical and cultural narratives. For instance, belligerent antagonists might make sense of conflict by telling credible stories reflecting the master narratives of the groups they belong to. Hammack emphasises the importance of religious master narratives as templates for social structure and culture life. As we see in the West, the removal of religious master narratives can have a significant negative effect on ethical behaviour if they are not replaced by something that provides clear moral and behavioural guidelines. As yet, we don’t seem to have provided the alternative. Hammack (2011) discusses the perennial problem of Israel versus Palestine in terms of the establishment of the conflicting master narratives. He argues that the Jewish-Israeli master narrative has four main themes: 1. 2. 3. 4.

A sense of persecution and victimisation leading to the Holocaust Existential insecurity, leading to Israel having a siege mentality Moral exceptionalism. The Jews are the Chosen People Delegitimisation of the Palestinian people

These themes persevere for several reasons. They are in essence why Israel continues to exist as a specifically Jewish nation surrounded by, as it perceives and with some reality, hostile people. If we believe that the Jewish people who

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Politics

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‘returned’ from Europe after the war are genetic Jews, then in one sense all the peoples around the area are semites, Arabs and Israelis, which in itself suggests they should get on well together. Inevitably, if there are ‘blood’ links between Arabs and Jews, it is the stories, the master narratives, that contribute significantly to the continuing wars and hatred, not any genetic reality. The sense of persecution experienced by the Jews has a historical reality. Jews have been persecuted in Europe for centuries, culminating in the Holocaust, which led to the deaths of an unknown number of Jews (probably between 5 and 6 million – we simply do not know because so many records were destroyed in the war). This is at least in part because of their self-defined otherness, their refusal to integrate into the societies in which they live (which has potential negative implications for the modern master narrative of multiculturalism). This is associated strongly with the Jewish sense of being the Chosen People, as expressed in the religious writings regarding Judaism, the idea that ‘we are better than you’. It arises directly through the dominance of the Christian religion, where Christians took on the Jewish Jesus and made him their own, when the Jews themselves had rejected his godhead. Hammack’s other themes are also linked. Israel’s existential insecurity and siege mentality have arisen directly because of the way in which Israel was formed, through war and the ejection of many of the indigenous people of what became Israel. This act, which has no international or moral legitimacy, forced the Israeli people to delegitimise the Palestinian people. They were forced to argue that there were no indigenous people, and those that were there were nomadic tribes who had no land ownership. The above two paragraphs have no sense of objective truth, they are purely narratives, master narratives, but they are powerful master narratives that have enabled Israel to exist as a Jewish state since 1948. They have a sense of truth to the Israeli people, even though those master narratives are rejected by others. This sense of power and truth shows the power of master narratives. On the Israeli side, these master narratives justify the existence of Israel as a Jewish state. On the opposite side, these master narratives are illegitimate and demonstrate that Israel as a Jewish state has no right to exist. No international declaration of the Jewish right to a state can override the power of master narratives.

Politics Master narratives can have a powerful effect, as we have seen regarding Israel. In more general terms, political violence arises out of certain master narratives. Master narratives can enable the radicalisation of certain

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elements of a population which can lead to changes in the master narrative. Sonnenschein and Lindgren (2020) discuss radicalisation as a social process, arguing that it evolves through interactions between the individual, the group and state actors, and it is through this process that master narratives can change. In one sense, radicalism is just about trying to change master narratives. Narratives are important in providing a dynamic exchange between the social context and the mind for constructing, structuring and maintaining realities when a few, a small proportion of a population, engage in political violence. Master narratives are, through political thought, words and action, continuously configured and reconfigured to define and redefine individuals, groups and nations. Radicalisation has three clear conditions. First, there is a perceived need for meaning (Hogg et al., 2010). Second, a perception of injustice and humiliation (Pargament et al., 2005). Third, a need for belonging. When these conditions are met, there may be an attempt by a group that does not accept the current master narrative to create fundamental change, to replace the master narrative with a new one. At its most radical, this is seen in rebellions and revolutions, such as the Bolsheviks in Russia in 1917. It can be seen in civil wars where one group wants fundamental change, such as Bosnia in the 1990s during the breakdown of Yugoslavia. Within a democracy, it can be about how a newly elected political party introduces radical changes to policy, such as Margaret Thatcher’s election in 1979. Framing theory (Wiktorowicz, 2005) shows how people see themselves as part of a group. We can characterise political positions and religious positions as frames. These frames identify movements’ struggles, showing one’s own group as the ingroup and adversaries as the outgroup (Israelis and Palestinians are a good example, Loyalists and Nationalists in Northern Ireland another). Framing others as the outgroup provides a legitimacy for action. These frames provide powerful narratives connecting the group to the past, present and future. Master narratives are created in the interests of the dominant classes and institutions (Harris et al., 2001), preserving the superior position of elites (Delgado, 1989). The power of master narratives derived from five principles: utility, ubiquity, rigidity, their compulsory nature and invisibility. Invisibility is about the internalisation of master narratives, which is a key vehicle for their reproduction. If people don’t notice changes, then they can occur without a great deal of conflict. In many cases, this is not problematic, sometimes it creates problems, but these problems may not be noticed at first. For example, in the UK, the notion of trespass, which

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is when someone goes on another person’s land without permission. This was relatively rare when land was held by lords but was used in common; but with successive enclosure acts, there was less and less land available for use in common. This may be seen as the gradual stealing of land for the use of the few. It is now accepted that there are boundaries and very few people are allowed into most of the land. As master narratives are largely implicit, people are not aware of them, though they largely behave according to the ‘rules’ of the master narrative. To make changes, individuals or groups publicise what they want to do and try to persuade people to want and fight (literally or figuratively) for change. Master narratives can occur within a particular field or discipline. For instance, within psychology, there is a master narrative that the medical model of mental illness is the best model to use to help people who have mental health problems. There is, though, a significant group of practitioners who reject the medical model approach and want to explain mental illness in other ways – often rejecting the term mental illness itself. Sometimes the conflict between master narratives can be productive, leading to positive change, for example, the development of theory or practice. At other times, the conflict appears irresolvable, with two or more groups working differently but in parallel, often using different terminology, practices and theory, finding it difficult to persuade and compare with each other because they are using fundamentally different languages to describe similar phenomena. This is where narrative explanations come into their own. A good example of a master narrative, indeed a master narrative that, though based on prejudices already extant in the society, is that of Hitler the story teller, as described by Burke (1939, in Halverston et al., 2011). Burke interpreted Hitler’s Mein Kampf and outlined a theory of narrative form as symbolic action – as communication. For Hitler, symbolic action was rooted in the standard storytelling device of defining a common enemy, in this case the Jews. Hitler used anecdotes regarding the Jews to create identification among his readers. His argument was that Germans have an inborn dignity (as a mythic Aryan race) that is sullied by people not of the same race, and that a German utopian society can only be founded by ridding the nation of these enemies. It is essential that the Germans fight the Jews to achieve this idealised society. The rhetorical organisation of the narrative is based on the belief that the present is defined by chaos, and that the very soul of the nation was tainted by Jews, bankers and immigrants, and that if the reader identified with the personal experiences of Hitler the story teller, they would also see themselves as having a place in the fight to purify the nation and establish the Aryan supremacy. Here,

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Hitler invoked God’s will, knowing that people will conform to religious ideals. Halverston et al. argue that the relationship between narrative form and political/ideological action is useful for three reasons: 1. They allow us to understand how many story forms follow the same master narrative (a story form is a standard pattern on which stories can be based, defining characters, actions, sequences of events). 2. They point out the critical role of archetypes (standard characters) as sources of cultural information relevant to narratives. 3. They show how abstract ideas of myth and social order can inform attempts to persuade others to accept a point of view. An integrative theory of human development involves engagement with the master narrative. People and settings are mutually constituted through a dynamic engagement with the symbolic meaning system of language within a society (Hammack & Toolis, 2015). This draws on a number of theoretical perspectives including Mead’s (1934) symbolic interactionism, Tajfel and Turner’s (1986) social identity theory, along with narrative approaches such as Bruner (1990) or McAdams (2001). This integrative theory enables an understanding of the power of social structures and social categorisation to shape individual subjectivity (not just behaviour but the way we think and feel). Hammack and Toolis (2015) note that their fundamental premise is that it is through a dynamic engagement with master narratives that both individual and cultural development occur; there is an evolution of thinking and behaviour in societies. This is an important concept when examining master narratives, seeing how the individual and the social interact to lead to societal development. It is when these processes are disrupted that there is significant conflict within society and between people. It is a reason why multiculturalism is problematic.

Problems of Multiculturalism If we apply the master narrative to some of the problems in society, we may begin to understand why there are problems. A good example is multiculturalism. By definition, if we have a multicultural society, we have two or more master narratives, which by definition are conflictual simply because there will be key elements of the two (or more) master narratives that are not in agreement. It may be a better strategy to have a single master narrative and encourage the integration of migrants. This is not to say that people should not bring their useful and interesting cultural elements

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Problems of Multiculturalism

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to a new society. It is perfectly possible and normal to integrate new elements into the dominant master narrative. One problem of multiculturalism is that it restricts a sense of belonging to a particular nation state or culture with all that entails, not bigoted narrow nationalism, but the legal system, mores, norms and expectations regarding behaviour. While there are many problems with the nation state, most of us buy into the ideas of its culture and laws. It is impossible to have this sense of unity if some people see themselves as belonging to a particular ethnic or racial group rather than citizens of a common country. While there is an elitist view, one that is widely accepted among the liberal classes, that multiculturalism is a good thing, there are several problems with this. The first is that multiculturalism privileges certain groups over the common good, which has the potential problem of eroding the values of a society in favour of minority interests. The example of Islam in the West given earlier is a good example of this. If we privilege the antiliberal elements of Islam over our liberal society, we create the possibility of negating liberalism itself which has many – largely negative – implications. There is a strong illiberal movement in Western society, led by the liberal left, which appears to negate elements of the Western master narrative such as the benefits of European civilisation and progress in favour of strongly defending minorities, encouraging the employment of certain groups above the majority, encouraging diversity at the expense of equality, arguing for systematic racism (whatever that is), considering virtually any criticism of minorities (in its broadest sense) as fundamentally wrong, thus limiting free speech. While most of us would accept that free speech has limitations, certainly that we should not encourage the harm of others, this should not be to the extent that we cannot criticise – for instance – religion. Criticisms of religion in many ways led to our enlightened society. Fundamentally, restricting free speech through a defence of multiculturalism undermines the idea that we have equal rights. Giving more rights to certain groups, whoever they are, weakens the moral and political value of equal treatment in a fair society. By restricting the rights of some people in favour of the rights of certain groups, we are undermining the fundamental values that are part of the master narratives of our societies. Multiculturalism also raises the question of which cultures are to be recognised within a multicultural society. After all, they must be recognised otherwise, by definition, society is not multicultural. We may end up with different groups vying for recognition which further highlights the differences between cultures, further separating us and perhaps leading to clashes between cultures, which is another potential problem. Social

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psychology tells us that we have ingroups and outgroups (Tajfel & Turner, 1979), and that conflict between groups is common, with people cohering within their group at the expense of other groups. The more we have this within a society, the more problematic it may become. In the end, the dominant culture may see itself as endangered and in need of protection. This is happening across Europe in the form of growing numbers of people belonging to far right groups who are unhappy that Europe has become multicultural and see a genuine risk to traditional notions of liberal and open Europe. There is a further complication that we may be in the strange position whereby far right non-liberals are in effect trying to preserve liberal society while liberals are effectively destroying it! Which aspects of particular cultures should be recognised? In the West, feminists have fought for years to obtain parity in the social and political spheres with men, and this has generally (with exceptions) been achieved, though it was never so simple that men had power and women didn’t. Women have always had more power in Western society than is recognised. Other cultures do not recognise the equality of women. What should we in the West do about that? We only undermine our own culture if we enable certain groups to differentiate men and women, and this happens in mosques and synagogues where men and women are separated, or in situations where women are compelled to wear some form of head covering. I recognise there is an argument that women choose to wear head coverings, but this itself may be a demonstration of how master narratives become part of personal narratives; in this case, the master narrative of telling women to wear head coverings becomes part of the personal narratives of many women. Personally, I learned something important when flying into Tehran. As we approached the airport, all the Iranian women covered their hair. A few days later as we flew out of the airport, the women aboard all took off their head coverings. This is not rigorous evidence, but it may be an indication of how many women feel about head coverings. The main point is that if a multicultural society means adopting or accepting practices that are considered unfair, then that is a good argument against multiculturalism. Logically, if there are aspects of another culture that is acceptable to a given culture, then it is likely to be assimilated. A good example in the UK is Indian food. From being very rare immediately after World War II, it is now ubiquitous; it has become part of British food culture. Instead of accepting multiculturalism, we should be assimilating parts of other cultures into our own, which means assimilating the people into our own culture. In the UK, this is generally what we have done in the past. We

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Counter Narratives

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take the best of different cultures and call it our own. It has only become difficult to do this with mass immigration, where people of a particular culture tend to congregate together and hence delay their absorption into society. This is often exacerbated by not learning and using the language of the dominant culture. These arguments could fill a book in themselves. The point here is to illustrate the importance of employing master narratives to help us understand social behaviour. In a multicultural society, there are several master narratives that must, by definition, conflict. If they did not conflict, then there would not be a multicultural society because everyone would accept similar norms and rules of behaviour. In essence, multiculturalism is primarily about conflict. Within a given society, it is not possible for multiple cultures to co-exist without conflict, as they, again by definition, have at least some conflicting elements.

Counter Narratives Counter narratives are not the same as conflicting narratives, though there is a point at which a counter narrative could become a conflicting narrative if it starts to undermine the traditional structure of the dominant master narrative. A counter narrative exists within a master narrative, disputing elements of the master narrative, trying to change elements, yet fundamentally not trying to undermine the whole structure in the way a conflicting master narrative might. A counter narrative may want to change elements of society. For instance, the punk movement of the late 1970s in the UK wanted to change parts of society. In some ways, it claimed it wanted fundamental change (Anarchy in the UK), but in reality, the changes reflected some of the problems facing society and offering solutions (Alternative Ulster, White Riot). There is less attention on how personal narratives influence and change master narratives (Hochman & Spector-Mersel, 2020). Andrews (2004) explored how in counter narratives, people’s personal narratives are active players in shaping and reshaping culture. Individuals can transform master narratives through narrative resistance (Ronai & Cross, 1998), and counter narratives become vehicles of de-stigmatisation (Toolis & Hammack, 2015), so people can still fit into the higher-level master narrative in order to function (crudely, punks wanted an Alternative Ulster, but they didn’t mind driving on the left and drinking beer in pubs). Counter narratives are defined ambiguously. What do they contain? When do they become counter narratives? Other terms such as subversive stories (Ewick & Silbey, 1995)

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are used. The only agreement is that they challenge received wisdom, and that they always function in relation to other narratives; they are positional categories that involve a stance towards master narratives. Counter narratives can have two meanings: 1. Oppositional – counter narratives are told by people belonging to marginalised groups and they contradict master narratives (Delgado, 1989; Solorzano & Yozzo, 2002). They are a means of political agitation. 2. Relational – counter narratives and master narratives are not dichotomous entities – whether a social/individual narrative relates to a master narrative or a counter narrative depends on context, who is telling and why, when and to whom (Harris et al., 2001). While there may be elements of both in most challenges to the master narrative, most research has focused on the relational view, with most counter narratives accepting some aspects of the master narrative and rejecting others, rather than two monolithic narratives colliding as we get with conflicting master narratives. The diverse forms in which individuals do narrative resistance is understudied. Most research focusses on the content of the counter narrative rather than how they counter. Cordell and Ronai (1999) examined three discursive strategies of narrative resistance by overweight women: rejecting deviance, distancing the self from others marked by similar stigmas and excepting self from deviance by describing factors contributing to their being overweight. Saguy and Ward (2011) examined another form, that of coming out, such as coming out as homosexual or choosing to come out as fat.

Constraints People are inevitably fundamentally constrained by master narratives, including during identity development, and so we take on the expectations of society through socialisation. The debate within psychology is the extent to which we employ free will to develop and change, and the extent to which the master narrative dictates who we are. This goes beyond the inevitable constraints arising from our genetic heritage. The concept of agency is important in applied psychology. If our applications are going to be of any value, we have to assume that people and social structures can change, and we need to know how they can change. The construct of master narratives can aid the development of occupational, clinical, health and

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forensic psychology through employing specific methods acknowledging the importance of these constraints. When people are telling us a story, whether that is about their personal biography such as mental or physical health, or about social structures such as their workplace, they are not free to tell any story they like, they are constrained by the master narrative. For instance, the language of mental illness has gradually crept into the mainstream and people will discuss their experiences and feelings in terms of the categories of mental illness used professionally by psychologists and psychiatrists, for example, posttraumatic stress disorder (PTSD), anxiety and depression. They use these terms without necessarily understanding them as medical constructs, and so end up simplifying their described experiences using concepts they do not fully understand, thus weakening their argument. Mental health is a stigmatising master narrative, no matter what we are told in the media and by health workers and politicians that there is an equivalence between physical and mental illness. The key interpretative point from the professional’s position is to recognise that when people are telling them stories, these stories are not just personal, but dictated by the master narrative, and the professional should – where possible – take account of this.

Postmodernism There is debate around the modern versus postmodern conceptualisation of master narratives. Traditionally, master narratives are understood within a modernist perspective; they provide a pragmatic explanation regarding the commonalities that occur across members of a society. If we wish to counter these master narratives, then, it might be argued, the postmodern approach provides the means to criticise not only the content of master narratives (for example, we live in a multicultural world that has multiple legitimate narratives) but also the concept of the master narrative, in that if we are free-thinking individuals, then we have the right to make decisions freely without the constraints of a master narrative, and that in effect, the concept of master narrative has little relevance because we are free-thinking and can easily overturn traditional ways of thinking and replace them with others. In reality, the debate between modernism and postmodernism is a little artificial, we live in an actual world (as Bruner might say), where normal people go around generally within the constraints of social pressures, though sometimes bending or breaking the rules in order to achieve some

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goal. Effectively, the master narratives exist (though they may conflict) and they evolve. Rejecting master narratives as some sort of postmodernist argument may be suitable for philosophical debate in academia but is not practical in the real world, and as this book is about applying psychology in the real world, we accept the concept of the master narrative. The terms meta-narrative and grand narrative are sometimes used when describing master narratives, particularly in critical theory. It is from here that Jean-Francois Lyotard (1984) claimed that the postmodern world was characterised by a mistrust of the idea of the grand narrative, that such narratives are inappropriately constraining in the real social world. Foucault (see Gutting, 2007) criticised the grand or master narrative because it rejects the naturally existing chaos and disorder of the real world and the importance of the individual and their behaviour. Lyotard argued that instead of grand narratives, we should focus instead on more ‘localised’ narratives, local context and the diversity of human experience. This leads to the argument that there are a multiplicity of theoretical positions rather than a small number of all-encompassing theories. We could get bogged down in arguing about these theories, but the notion of master narratives has its uses.

Ethics and the Master Narrative There are clear ethical implications around the construct of master narrative. Ethical behaviour depends on making ethical choices, and the compulsion of the master narrative means that many of those choices are made for us. To take an extreme example, in Nazi Germany, the antisemitism of the leadership, which was ingrained into policy, meant that the populace as a whole, whether or not they were personally antisemitic (and many of them were, not just in Germany but across Europe, just as now many people are racist regarding various groups), were directed as necessary into antisemitic behaviour, whether that was at the relatively low level (compared with what came later) of refusing to use Jewish shops and other businesses in the 1930s or the extreme measures implemented in the Final Solution such as working at or with extermination camps or the Einsatzgruppen who systematically murdered Jews and others in Eastern Europe. The master narrative of Nazism determined which kinds of behaviour were ethical. As the master narrative was not universally accepted, there were protests and people did work against it, but there were surprisingly few resistance movements to the Nazis as they very quickly took complete control over most aspects of society, from education to international policy.

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This raises the question over the extent to which ethics is a personal choice or one dictated by society. In Germany after the war, a common rationale for antisemitism was that ‘I was only following orders’, thus attempting to absolve one of personal ethical responsibility. For many years after the war, there was a debate about this, culminating in Stanley Milgram’s series of experiments which did appear to show that people would be willing to inflict harm on others just on the basis of being given an order. McLean and Syed (2016) advanced three propositions about the relationships among master narratives, ethics and morality: 1. Master narratives are fundamentally about ethics in that they outline and convey culturally held ideas about the nature of a good life. 2. While all master narratives are grounded in ethics, not all master narratives are moral. 3. Despite proposition two, master narratives can come to exert moral force. Personal narratives are fundamentally entwined with ethical and moral reasoning, at least in part because narratives and autobiographical reasoning make sense of behaviour. Logically, the master narrative must play a part as it is the master narrative that provides the general set of rules governing morality and ethics, it tells us in general terms what we should and should not do in given situations. There is no objective idea about what is right and wrong, these ideas change over time, that is, the master narrative changes. While it was acceptable to have legal sex differences regarding employment in the past, it is no longer acceptable. While it was acceptable to demonstrate sexuality or racial bias, that is no longer the case. These two examples apply in the West and in some other countries, but they do not apply in many places. Many countries, particularly in Africa and the Arab world, retain strong laws against homosexuality and against the equality of the sexes.

Conclusion Master narratives are crucial to understanding human behaviour. They are largely implicit in what we do. If we live within a given master narrative, we simply know how to behave. We learn how to do so as children through socialisation. A term used by Anthony Giddens is that the narrative is so deeply embedded in a social system that it is ‘chronically reproduced’, told again and again over time, and it is resistant to change.

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Master narratives can have a powerful effect, as we have seen regarding Israel. In more general terms, political violence arises out of certain master narratives. Master narratives can enable the radicalisation of certain elements of a population which can itself lead to changes in the master narrative. Sonnenschein and Lindgren (2020) discuss radicalisation as a social process, arguing that it evolves through interactions between the individual, the group and state actors, and it is through this process that master narratives can change. In one sense, radicalism is just about trying to change master narratives. Narratives are important in providing a dynamic exchange between the social context and the mind for constructing, structuring and maintaining realities when a few, a small proportion of a population, engage in political violence. Master narratives are, through political thought, words and action, continuously configured and reconfigured to define and redefine individuals, groups and nations. Radicalisation has three clear conditions. First, there is a perceived need for meaning (Hogg et al., 2010). Second, a perception of injustice and humiliation (Pargament et al., 2005). Third, a need for belonging. In the end, narrative identity is both personal and cultural; individuals follow scripts that constrain agency by privileging certain types of stories (Hammack, 2008; McLean & Syed, 2016a). Identity itself is a psychosocial construction. Master narratives are the main conceptual framework for describing the influence of culture on personal stories. Other terms include canonical narratives (Bruner, 1990), dominant cultural narratives (Andrews, 2004) and hegemonic tales (Ewick & Silbey, 1995). Master narratives provide guidance about how to be a good member of a culture (McLean & Syed, 2016). They are the blueprint for all stories, how we understand ourselves and others (Hochman & Specot-Mersel, 2020). Master narratives are critical to psychological understanding, not only in social psychology, because the master narratives in society affect our behaviour, thinking and feeling at all levels, including the individual. We respond to everything at least in part due to master narratives. We have a reasonably good understanding of the nature of master narratives though, as is the case within much of narrative psychology, testing these master narratives has been limited. As applied psychologists, we need to take master narratives into account when we are trying to understand the problems we are dealing with, whether that is at the individual or the social level. Master narratives function in organisations, prisons and the social world generally.

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Chapter 5

Narrative Methods

There are no fixed rules for how we should obtain narratives, for example, through interviews, looking at journals or watching films. And there is no agreement on how to analyse narrative data. This is rather a difficult position, for a practical applied book. Nevertheless, we can find practical solutions to practical narrative problems. Narrative analysis is usually qualitative, where we attempt to make sense of a script in narrative terms and draw conclusions about the coherence of the narrative, the meaning of the script or some other factor. This can be difficult due to the complexity of narrative and the lack of objective methods, but by focusing on the key aspects of narrative as discussed in earlier chapters, we can make sense of the stories that we see. Narrative is sometimes analysed quantitatively but this involves translating an essentially qualitative story into numbers, which is not always practical or desirable, and inevitably loses the essential point of narrative understanding. Many aspects of psychological life cannot be reduced to quanta and may be a lesson for other areas of psychology where human behaviour is oversimplified. Earlier I discussed how we can look at narrative as a fundamental basis for human existence. We all use narrative processes and in principle, we can identify these processes as part of brain functioning. At another level, narrative is socially constructed, and so narrative analysis must be derived from narrative constructionism (Smith & Monforte, 2020). Stories do more than simply reflect or recount experience, they act in people’s lives in ways that matter deeply. Any narrative analysis must recognise this. What is narrative analysis and how is it differentiated from other forms of qualitative analysis? There are philosophical assumptions such as ontological relativism, which recognises the real physical world, but psychological phenomena are multiple, created and dependent on us, as opposed to existing independently. Epistemological constructionism (Smith, 2013) suggests knowledge is constructed and fallible. Fundamentally, we live in a world subject to the laws of physics but we have minds that – at least according to 63

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our current understanding – have elements that are continually constructed and reconstructed. Our stories do not depend solely on physical reality, but on the content and structure of our thinking and feeling. Narrative constructionism sees humans as meaning-makers who use narrative to interpret, direct and communicate life, configure experience and give a sense of who they are. Meaning-making is central to narrative and so must be central to any narrative analysis. Narratives are passed down in people’s social and cultural worlds. These are important constructs, enabling us to differentiate between a socially constructed world which rests on very little, and a social constructed world which is subject to scientific laws and procedures. It forms the link between realism and relativism.

What Is a Narrative Interview? The narrative interview is the main technique used in narrative research. In this chapter, we examine the general principles; later chapters explore specific types of narrative interview. Not all interviews are narrative in style or function, so the researcher must ensure that the data produced are in story form. The narrative interview is inevitably a narrow focus, and there are other narrative approaches, particularly analysing extant narratives such as novels, journals or other accounts. Fundamentally, a narrative analysis analyses narrative data, irrespective of its derivation.

Messy Data Narrative research is messy. This may put some people off, but it is true. It is not always even clear what constitutes data (Andrews, 2020). Data are everywhere, from written stories to interviews to talks in the pub to pictures on a wall to films on the TV. Even when we have the most straightforward data source, the interview, we have to take into account not only what someone said but also the way they said it, their emotional reaction and so on. Narrative depends on context and so requires a subtle approach, not only considering what is said but also non-verbal elements of communication, hesitations, emotions, etc. We also have to take into account also the world around the interviewee, as this provides context. When we speak, we take many things for granted, there are often nuances in the choice of words and phrases, not only idiomatic language but also words that have several meanings depending on how they are used, and words that have different meanings for different people, which is why someone from a different culture may have difficulty fully understanding someone.

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Another form of messiness is the nature of the stories themselves. They are often not objectively true. They may be entirely false. This may or may not be known even to the speaker, let alone the interviewer. Elements of the story may be accurate, but others are not accurate. There is a whole subjective dimension to narrative that cannot and should not be removed. It is part of the nature of narrative. Somehow in the narrative analysis, we have to sort this mess out. When conducting a narrative analysis, we have to make decisions about what is important and what is not important. For instance, in my own work (e.g. Hunt & Robbins, 2001), I interviewed World War II veterans about their experiences in the war and the impact these experiences had on them. I quickly realised that not everyone told the truth about their experiences, either enhancing or demeaning their role, or simply not being able to remember, or, in one memorable case, one veteran paratrooper told me in great detail about what was happening several miles from where he was fighting. As a sergeant, there is no way he would have such an overview. It was only when I saw all the books and films he had about the battle in question that I realised that he had blended his experiences with what he had later read and seen. This is not necessarily untruthful, it is the way narratives work, drawing together stories derived from real events, what one has been told, what one has read and seen and how one interprets the information. We do not remember things in isolation. The paratrooper (probably) genuinely thought he remembered incidents he could only have learned about afterwards. Memories are not fixed; they are manipulable by the development of narratives. We remember what is useful to us – and we also selectively forget. The importance of this in terms of the narrative method is that we – as psychologists – have to realise that we are interested more in psychological processes than in objective historical truth. When we carry out a narrative interview to explore some aspect of a person’s life, we are interested in their interpretation of what happened and the impact it had on them and others more than we are interested in what actually happened. We are not historians or police officers.

What Is Narrative Analysis? Narrative analysis claims to be holistic, analysing a text at the macro level. Nevertheless, as we have seen in earlier chapters, we must examine the elements of a narrative in order to explain the totality. Narratology describes the limited number of elements and variations of elements in

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narrative composition (Onega & Landa, 1996). Time, structure characters, agency, coherence, evaluation and spatial and interpersonal relations of characters are all important. There are a limited number of elements which correspond to limited number of psychological constructions, whereas the text itself can be endlessly variable at the surface level. Quantitative approaches to narrative based on the narrative compositional elements use algorithms that are able to automatically detect and process each feature. This is radically different from most narrative analysis and will not be considered here (see Franzosi, 2010, for details of quantitative narrative analysis). There are several problems when studying narratives. For instance, there are no agreed start and end points for many stories (Andrews, 2020); this is usually the case when we are studying human stories. We do not want to study the whole of someone’s life. We are probably interested in a transition. In this case, we may look at three elements, before the transition, during the transition and after the transition – but who determines which elements of life we examine before or after the transition? Who determines what is or might be important? There is no clear answer. According to Riessman (2008), narrative analysis is a family of methods that share a common focus on stories. This needs to be unpacked further. When looking at the types of narrative analysis, we should not, as some may do, restrict ourselves to a particular approach, we should be employing the best narrative method for the job in hand. As Smith and Monteforte (2020) argue, ‘a researcher does not have to pledge allegiance to one standpoint only and see the other as a family enemy’ (p. 2). It is important to differentiate between the story teller and the story analyst (Bochner & Riggs, 2013; Smith & Sparks, 2006). Do we even need to analyse the story or can we just tell it and leave it at that? The decision regarding analysis should be made at the outset of the research. The story itself may be the analysis. Outside the story, we may be interested in the impact of telling the story (see Chapter 9 on Narrative Exposure Therapy). Story analyst and story teller may describe a particular form of constructivist narrative analysis, dialogic narrative analysis. Dialogic narrative is a mirroring of what is told (the content) and what happens as a result of telling (effects), that is, includes what stories do (Frank, 2010, 2012). When operating as a story teller, the analysis is the story and the story is communicated in the form of a creative analytic practice (CAP) to produce the tale as a story. The researcher retells parts of the story to share the participants’ experiences. The result is a story rather than a traditional research report. The story itself is the analysis. One example is CAP (Richardson, 2000).

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CAP is an umbrella term for research cast into evocative and creative nonfiction where findings are conveyed in the form of fictional tales grounded in empirical data.

Indicators of Quality of Narrative Research Any scientific approach must have appropriate indicators of quality such as reliability and validity to ensure that the research has been conducted in the best possible way, and that any potential problems are highlighted and can if possible be rectified. These qualities include: 1. Trustworthiness. According to Reissman (2008), a narrative account must be plausible, reasonable and convincing. These are difficult qualities to quantify or operationalise, but the researcher can examine different accounts or negative cases, and can explore alternative interpretations of the data. 2. Critical reflexivity. The researcher should take a reflexive stance, examining the nature of the participants (are they the right ones? Did they answer the questions as truthfully as possible?), how did the researcher approach the topic, the people, the narrative accounts? How are the researcher’s biases showing in the research and how are they dealt with? Are the results interpreted appropriately, are they reliable? Is there any sense in which they have broader generalisability (not necessarily relevant)? 3. Co-construction of meaning. As we will see in Chapter 9, where co-construction is explicit, most narratives, and certainly those that are interviews, are co-constructed. There is no meaning that is pure to the participant; it is always affected by the people around them and their environment. Meaning is always created, modified, contested and resisted. The researcher must be sensitive to how meaning is created. 4. Related to co-constructionism are those elements that are not said, that may be implicit in the construction of the narrative. There may be characters that are not discussed but impacted the formation of the narrative (e.g. a teacher or respected colleague). As Freeman (2004) notes, this is the presence of what is missing. 5. Temporal fluidity. Stories do not stand still. They are constantly changing, whether this is explicit or implicit reconstruction. Life does not stand still for the person, new information is constantly brought into the life narrative and new interpretations of past events are created.

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6. Multi-layered stories. Stories are told in different ways to different people (including oneself). Stories may be explicitly about a single person, yet above this are social and cultural levels of understanding. 7. Stories are always told contextually. This is not only about broader cultural aspects but the immediate context of the story. Someone tells their life story different to a spouse, to a group of friends in a pub or to work colleagues. The audience matters. 8. Scholarship. Good narrative research should be contextualised within other scientific work within the area (both of narrative and the topic under consideration). 9. Ethics. As with all psychological research, there are ethical considerations with narrative research. These will depend on the specific research and the context, but should always be taken into consideration.

Practicalities of Narrative Analysis There are numerous strategies suggested for how to conduct narrative interviews and carry out the analysis. It is essential that the interview process and the analytic strategy are matched to ensure that the researcher is collecting data that can be analysed in a narrative fashion. Several authors have discussed issues around narrative analysis. What follows is a hopefully straightforward account of how to conduct such an analysis. Narrative researchers will undoubtedly disagree on some of the points, and may argue for a more theoretically or philosophically driven approach, but in the end, this is an applied book, and as such it is best for the reader to provide a practical means of conducting the analysis which works. I am not arguing that this is the only right way nor that it accounts for the work that exists in narrative theory, but it should help the beginning narrative researcher, and provide a practical guide to interviewing and analysis. Analysis of narratives may involve grounded theory (GT) (Strauss & Corbin, 2014), thematic analysis (TA) (Braun & Clarke, 2019) or interpretative phenomenological analysis (IPA, Smith, 2011). It is acceptable and appropriate to use these techniques as part of your analytic strategy depending on the purpose of your study. In particular, IPA is very useful with narrative work as it focuses on the particular experiences of the individual and enables an examination of the process of events and experiences in the person’s life – which is central to narrative. The analytic process for narrative interviews is cyclical and iterative rather than linear and fixed, so expect to go backwards and forwards

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through the process. Depending on the way you are doing your narrative interview, this could involve the interview itself (See Chapters 8 and 9). This is broken down into four main sections: 1. 2. 3. 4.

The interview Familiarisation Research questions Pulling it together

1. The Narrative Interview First of all, the narrative researcher has to decide what the story is and how the story can be collected (if extant) or constructed. Extant stories can be things such as books, journals, diaries or blogs, while constructed stories are usually constructed via one or more interviews. We will be exploring types of interviews in this and in future chapters. The interview is transcribed, the level of transcription, what elements are included (e.g. pauses, emotion and volume). The transcription itself is an active process, and the researcher should be noting down anything that comes to mind as they do the transcription. The researcher often has the transcription done automatically or by others. This is not a problem, but the researcher should go through the interview in detail, checking the accuracy of the transcription. Narrative interviews ask big questions, prompting participants to look backwards and make evaluations about the past and forward to share predictions and hopes about the future (McAdams, 2007) or to describe ‘selfdefining memories’ (Singer et al., 2013). People report on major life events and personal evolution across the lifespan, and to make meaning, interpret these experiences. 2. Familiarisation and Initial Analysis The researcher should be highly familiar with the story. While it will become familiar during the interview, it is essential that it is read and reread several times, with the researcher immersing themselves in the data and making notes as they go along. How they deal with this will depend on how they are wanting to analyse the information, and this varies. As already noted, sometimes the story itself is the analysis. It is presented as a whole or in significant chunks. On other occasions, the story is subjected to further analysis, and this can be using general principles of qualitative analysis, for example, IPA or TA, as long as the end result is the story is retained (otherwise it is not a narrative analysis). During this phase, the researcher gets to grips with the stories, perhaps looking for classic elements such as orientation, coherence, characters,

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relationships, temporality and so on. It is about identifying narrative themes and narrative tone. What are the commonalities within and sometimes between stories? While it is important to highlight key points, it is equally important not to overcode. Don’t code line by line, don’t lose the story, look for the bigger patterns. Identify the structure, how the story is put together and shaped. Look for the directions the story goes, anything that suggests structure, reflections, evaluation, changes in tone, the objectives of the story, changes to characters and significant interactions between characters. 3. Research Questions This is a means of opening up the dialogue further, addressing specific questions of interest in relation to the stories. How do people construct and shape their stories? What narrative resources do individual participants have access to? Not all people have equal narrative resources. Do they need assistance in constructing narratives? What about identity? How do the stories inform about the identities of the participants and of the characters in the stories? What about the body? There is a close link between stories and the reactions of the body to the story. What thoughts and feelings are generated in relation to the story? 4. Pulling It All Together For publication in traditional journals, which is what most academic narrative researchers wish to do, the standard academic structure of an article must be, at least to some extent, adhered to. Fortunately, increasing numbers of journals are accepting of qualitative research in general and narrative research in particular, so the choice for publication is widening. The actual structure of the article will depend to some extent on the type of analysis used, and whether there is a need to integrate the results and discussion sections. It will also depend on the extent of quotations given. For narratives, the quotations are often long and may be at least partly self-explanatory. Another way of distinguishing types of narrative analysis is via codified (Chamberlain, 2011) and prescriptive (Frank, 2010). Both include a set of prescribed steps or procedures that the analysis should follow, for example, IPA, TA or GT. Frank (2010) provides a heuristic guide, a guide to interpretation, rather than leaving the analysis as a vague guess at the meaning of a narrative. This is useful for narrative analysis as, according to Frank (p. 73), ‘too many methods seem to prevent thought from moving’. Systematic and rigorous guidance can help the analyst with fresh directions and encourage theoretical curiosity and movements of thought.

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Narrative Coherence As an example of how narrative analysis can be specific to a particular situation, we conducted some research examining the importance of narrative coherence in traumatic stress, exploring the assumption that when someone is describing their difficult experiences in the past, the greater the degree of narrative coherence, the lower the level of post-traumatic stress disorder (PTSD) or trauma (Burnell et al., 2006, 2009a, 2009b, 2010). Narrative is used within mental health to understand how people make sense of events that challenge their ideas about the self and the world. The narratives here focused on narrative form and narrative content in relation to British war veterans. Narrative form is concerned with how people tell their stories. Narrative content consists of what people say relating to plot, characters and so on. For this study, which looked at the role of social support in veterans, narrative content focused on the social support experiences of the veterans. Narrative form concerned the coherence of the narrative, which was defined as an oriented, structured, affectively consistent and integrated narrative. In order for a narrative to be considered coherent, it has to have all the characteristics listed. Burnell et al. (2010) described the narratives of ten British World War II veterans in relation to social support experiences. Veterans with coherent narratives were less likely to have experienced (or reported) traumatic memories compared with those with reconciled or incoherent narratives, but they reported more positive perceptions of their war experience, more positive experiences of their families and of society.

Reliability and Validity of Narrative Analysis All analysis, whether qualitative or quantitative, is subjective and open to various forms of interpretation. How can we know what the ‘right answer’ is? This is important for applied psychologists, who want to get it right so they can have confidence that they are helping people. Fisher (1989) defines two tests of narrative validity (which he also calls rationality). The first concerns probability, whether the narrative ‘hangs together’, whether it is coherent and makes sense. Fisher uses the example of stories from the Bible. Some stories show that God cares if humanity believes in him, and others show that he doesn’t care. This is not consistent; it doesn’t make sense (though many religious people don’t seem to care). To be coherent, a collection of stories must be systematic, they must relate to one another in consistent ways and they must have a common

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theme. They must form a coherent structure where each story reinforces, elaborates or combines with the others to form a whole that is greater than the sum of the parts. Fisher’s second test of validity is narrative fidelity. Does the narrative relate to the reality of the world as most of us understand it? Despite important cultural differences, we all share basic desires for survival, security, safety, happiness and so on. There are also common situations where these are threatened (war, violence, etc.). We make narrative sense of these situations by establishing archetypal characters and relationships that rationalise these threats. For instance, a natural disaster can be explained as the action of a deity to publish sinners, or unusual weather patterns brought about by climate change. War could result from a villainous leadership of a country which wants to exploit the people of another country. A narrator makes sense of these negative events by framing them in this way. In the end, a narrative analysis cannot usually be expressed in a number indicating reliability or validity. An analysis depends on whether it appears appropriate. Nevertheless, there are times when numbers are appropriate, such as when we have used narratives to help reduce mental health symptoms (for instance, see Chapters 7 and 9), but this is one step removed from a narrative analysis, it is the analysis of the impact of constructing or reconstructing a narrative.

Conclusion This chapter has briefly examined the key practical elements of narrative analysis. These elements will be explored in further detail in the next few chapters, where we will see how researchers, clinicians and others use narrative analyses. There is no single way of doing narrative analysis. There is no textbook solution. Narrative analysis is about understanding stories. Stories take many forms, and researchers and clinicians analyse stories for many different reasons. While it might be thought to be practical to have a systematic proscribed approach, in actuality this would have serious practical limitations. We can add to the basics of analysis described above by looking at some real examples.

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Chapter 6

Life Interviews

Life interviews have been used for many years in a variety of ways for many different purposes. Biographies of famous people, or people who have achieved something significant, are common, and in recent decades, it has become more common for other people to provide their life stories to researchers for a variety of purposes. Providing a life story is not a simple matter. It is hardly possible to talk through one’s life, remembering the important points, dealing with key events, thoughts and feelings, without some structure. Often, a researcher might not be interested in a whole life story, but in some particular event or series of events, or a particular time in a person’s life, or they may be interested in finding out more about why a person thinks in the way they do, or how their thoughts and feelings link to important personal, social or national events. A life story is not necessarily about the whole of life, it can be, and often is, focused on more specific things. Many authors have used narrative storytelling in one form or another to indicate its effectiveness at reducing trauma-related symptoms and enhancing well-being. Storytelling itself appears to provide the person with an insight into the problems they are facing and helps them generate meaning from their experiences. A life story is a story in which an individual reflects on and engages with their experience and memories and tells the story to an audience (McLean & Syed, 2016). McAdams (2006) argues that the stories someone tells are embedded in our unique past and can also provide an insight into their current and future well-being. Burnell, Coleman and Hunt (2010) argued that the structure of the stories produced can predict whether someone is suffering from traumarelated symptoms. The more coherent a person’s narrative, the less likely they are to be suffering from trauma-related symptoms. This indicates that if a person’s narrative can be made more coherent, then perhaps this may reduce their trauma-related symptoms. 73

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The distinction often drawn between research and clinical practice, that a researcher should not be involved in therapy, is rather an artificial distinction in this kind of research. If a researcher is interviewing a person who has been through a traumatic experience about that traumatic experience, there is often an implicit therapeutic component. Talking about something really does make someone feel better. This is perhaps an example of how the therapeutic industry has attempted to isolate therapy and keep it to themselves, when the reality is that most therapy is informal and carried out by friends and family. The distinction between informal and formal therapy is fuzzy. Narrative is about opening up the process, to normalise it, to make it more natural, in the way that humans have done since they started to use narratives. That is not to say narratives can help with every psychological problem, but talking really does help with problems such as anxiety and depression. In this chapter, the focus will be on two specific ways of addressing the life story through interviews, MacAdams’ life story interviews (LSIs) and the narrative life interview (NLI). The two approaches are complementary, indeed the latter is partially based on the former, but they do offer different techniques to dealing with aspects of a person’s biography. They have different aims and are analysed differently.

McAdams Life Story Interview (LSI) The LSI was devised by McAdams (2006) to develop detailed and in-depth understanding of an individual’s life. The LSI encourages people to present their life story in chapters and to describe key elements within these chapters; moving on to explore high and low points in their lives, potential turning points, challenges faced, hopes for the future and to gain an insight into their personal beliefs and values, exploring the central themes in their lives (McAdams, 2008b). The LSI has been used in a variety of situations, but predominantly to understand transitions and turning points in people’s lives and the impact these have on lives. Leonard and Burns (2006) used this approach to investigate how, over several years, the life stories of middle-aged and older women shifted from a focus on transition (largely around the menopause) to a focus on personal growth and looked at the adverse situations they had faced. Adler et al. (2019), also focusing on adversity, examined people with mental health problems and how a positive life story can turn into a negative one, and how these stories are narrated in relation to the adversity experienced (a contaminated narrative). Alternatively, a negative event can be transformed through reflection and evaluation to have a positive outcome or develop into a redemptive

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narrative (Dunlop & Tracey, 2013; McAdams & McLean, 2013). Dunlop and Tracey also showed the importance of how a change to the narrative can lead to behavioural change and improved health.

Procedure for the LSI The LSI is a story about a person’s life, and so the questions that are addressed in the interview examine different aspects of life. The interview can take place over several sessions and several days, depending on the detail required, and is in several sections (for more detail see McAdams, 2007): A: Life Chapters Life is broken down into a number of chapters, usually between 2 and 7. Imagine a book with the titles of chapters. The person is asked to briefly describe the content of the chapters. B: Key Scenes in the Life Story The person is asked to describe certain key scenes in some detail. These include a high point in life, a low point, turning point, positive childhood memory, negative childhood memory, vivid adult memory, religious, mystical or spiritual experience, and wisdom event.1 C: Future Script What is the next chapter? How would the person describe their future? What do they hope to accomplish? What are their dreams, hopes and plans? Is there a life project? This might be a project about work, family or a hobby. D: Challenges What is the greatest single challenge in life? Where did the challenge come from, how did it develop and how was it resolved (if it was)? What was the greatest health challenge? What was the greatest loss of a person? What is the most important failure or regret in life? E: Personal Ideology This contains questions about fundamental beliefs and values in life. What is the person’s religious or ethical values? What are their social and political values? How have these values changed over time? What is the most important single value in life and why? Is there anything else to add about fundamental values, about the person’s fundamental philosophy of life? 1

The LSI can come across as very US-biased to the European mind. Many Europeans would say they haven’t had ‘religious, mystical or spiritual experiences’. The interview should be adapted accordingly. This may apply to several of the questions.

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F: Life Theme This would probably be unanswerable at the outset of the interview process, but does the person have a central theme, is there an idea that runs through the life story? G: Other Is there anything else that the person wishes to say that might add to the life story? The LSI does not attempt to cover everything in life. The purpose is to highlight the most important events and ideas, to give a flavour of the person’s experience and views. Once the interview is conducted, McAdams provides a series of ideas regarding the analysis of the LSI which enable a deeper understanding of the person. The key elements of this analysis are redemption and contamination. To some extent, these ideas are very North American, specifically USA, but to some extent, they are applicable to and useful for an understanding of narratives in general. This type of analysis was discussed in Chapter 5, Narrative Methods. Here the utility of such methods is briefly examined.

Redemption and Contamination McAdams (2001) discusses a number of concepts relating to narrative analysis. Perhaps the most useful of these are the ideas of redemption and contamination, though at times they do appear, at least to the European reader, a little – for the sake of a better word – American. Nevertheless, they do provide a useful way of examining narratives for positive and negative elements. The two strategies show how people make narrative sense of their experiences that involve a significant transition (McAdams & Bowman, 2001). In a redemptive sequence, the storyteller narratives a transformation from a negative life scene through to a good (or at least better) scene, with life improved in some way. In a contaminated sequence, the storyteller does the opposite, demonstrating a transformation from a positive scene to a negative one, with life spoiled in some way. McAdams et al. (1997) discuss generativity, with highly generative people narrating their lives in terms of commitment, and is related to a positive family life as a child, being sensitive to others’ suffering, being guided by a clear and stable personal ideology, wishes to benefit society and tends to transform bad scenes into good ones (redemptive sequence). Highly generative people were also less likely to narrative their lives in terms of a contamination sequence.

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Redemption The coding scheme for redemption relies on the work of a number of people, particularly writings on redemption scenes and commitment (Carlson, 1988; Tomkins, 1987) and also the literature relating to traumatic growth (e.g. Tedeschi & Calhoun, 1995). A redemption sequence in a narrative may involve four separate elements: 1. 2. 3. 4.

Redemption imagery Enhanced agency Enhanced communion Ultimate concerns

Redemption imagery is when there is movement in a story from a clear negative scene to a clear positive scene. Negative scenes are often described in terms of a person’s emotional state, for instance, feelings of anger, sadness or grief. There may also be physical symptoms of pain or sickness. The event itself might relate to experiences such as the loss of a friend, an accident or losing one’s job. This is not about minor setbacks, but significant negative events in a person’s life that have negative outcomes for the person. It is, like all narrative analysis, a very personal and subjective decision, but this is inevitable when we are dealing with stories, no two of which are the same, though many are similar. If a redemptive sequence is present, once a negative scene is established, there needs to be evidence that the person has moved from this negative scene to a more positive one. This might be indicated through positive emotions such as happiness or love, or by cognitive elements such as increased self-awareness or positive thinking. This may also include events or scenes that most people would see as positive, such as being in a good relationship, getting a new desired job or being fully recovered from an illness. Another characteristic of determining whether there is a redemptive sequence is establishing causality. If there is a simple time lapse between the negative and positive scenes, this is not redemptive; there has to be some form of causal link (e.g. recovery from illness, developing a new relationship, gaining an understanding of suffering).

The Narrative Life Interview The NLI is a technique designed as a means of enabling people to tell their stories. It is an autobiographical technique derived in part from

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narrative exposure therapy (NET) (Schauer et al., 2011) and McAdams’ LSI (McAdams, 2007). It is derived from our understanding of how people construct, listen to and relate to people’s life stories, with the listener (the interviewer) playing a key role in that process, explicitly recognising the double hermeneutic present in narrative construction. It is a recognition of how it is common for a story to be constructed by two (or more) people, how stories are created within the social milieu of which they form part. The purpose of the NLI is not to cover in detail all aspects of a person’s life, but to focus on transition and the elements of the transition that have had the biggest effect on a person. The NLI can be used for any area where we wish to understand something about how people are affected by transitions. The focus around trauma will involve the lead up to the event or events, what actually happened (war, disaster, sexual abuse and rape, etc.) and the consequences of the event. For instance, for traumatic stress, it might involve a refugee’s experiences in their home country that led to becoming a refugee, the transition process and the experience of living in the host country. In occupational psychology, the focus might be a transition within an organisation, involving interviewing employees about their work experiences before, during and after the transition. In health psychology, the focus could be the experience of illness, or in forensic psychology, the experience of crime. It is always about the events leading up to the event, the event itself and the period after the event. The critical aspect of NLI is the focus not only on the person’s biographical details but also to focus on key behaviours, thoughts and feelings relating to the experience. If the focus is traumatic stress, then in terms of NET this would involve dealing with the ‘hot’ memories in detail, enabling the person to discuss them in detail and make the memories more bearable. As psychologists, we are interested in the details of the experience and the person’s response to the experience, so it is important for both research and practice to get information about behaviour, thoughts and feelings in as much detail as possible, which will have a benefit for knowledge and understanding regarding the human reaction to difficult events and a therapeutic benefit for the individual.

NLI Interview The interview has several elements: (a) assessment and psychoeducation. The NLI may have therapeutic benefits, so it is important for the person to be aware of the normality of the symptoms they may experience and to have the means (e.g. relaxation techniques) to cope during the interview,

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Details of the NLI Procedure

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(b) a long interview to obtain all key details of the interviewee’s experience, including behaviours, cognitions and emotions; (c) the interviewer writes up the story in the first person, noting where there are gaps, inconsistencies or other problems and sends the life story to the interviewee; (d) in a second, shorter, interview, the interviewer has the opportunity to complete the story, to fill in the gaps, clarify inconsistencies, etc., and the interviewee has the chance to add, remove or clarify information. The final transcript is then signed off by the interviewee. The purpose of the NLI is twofold. First, it is to enable the person to develop their autobiography more effectively, to make sense of their experiences and to integrate these into their autobiography. In this way, it is similar to NET, though as it only has two sessions, it should be used with people who have less serious problems, and who may benefit from this short technique. Second, to provide a transcript for researchers to analyse, using some form of narrative analysis (e.g. White, 2000) or interpretative phenomenological analysis (IPA) (Smith, 2011). The NLI is conducted across two sessions, with sufficient time between for the life story to be written up and critically analysed by both the interviewer and the interviewee. Based on evidence from other narrative procedures (e.g. McAdams, 2006; Schauer et al., 2011), people who have symptoms of trauma or anxiety may experience a reduction of those symptoms, simply by telling their story, so it may be important to have assessments before and after the procedure. Pilot research has examined the impact of the transition to university, with a focus on changes to, for instance, friendship, diet and attitudes. In this case, the NLI examined participants’ lives before, during and after the transition to university life, but with a focus on the changes to behaviour, cognitions and emotions. Similarly, other pilot research has examined changes to diet and to physical health. While these examples have a focused transition period, the principle of NLI only requires the detailed examination of behaviours, cognitions and emotions regarding the topic of interest, rather like NET. NLI focuses on a particular topic rather than on a participant’s whole life, which moves away from McAdams notions of examining life through chapters towards a consideration of the impact of critical events.

Details of the NLI Procedure The NLI has been piloted on several populations: war veterans, refugees, trans-people, people with autism and students transitioning to university.

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The advantage of the NLI is that it can be used with a wide variety of populations and not just with people who have mental health problems; so it is a highly versatile research tool. As already discussed, the NLI draws strongly on NET, the LSI and IPA to produce a co-constructed narrative based on the participant’s life, with a focus on the areas of importance (critical events, before transition, transition, after transition), whether it is a research or clinical-focused study. The actual process, the questions that are asked, depends to a large extent on the purpose of the procedure.

Diagnostic Elements and Psychoeducation Procedures relating to informing the person about the purpose of the NLI may be followed by measures relating to symptoms the individual might be facing such as depression or stress and anxiety. This may be partly to determine the extent of the problem and partly to examine whether the NLI process leads to significant change by reassessing the person after the procedure is complete. Psychoeducation is important to the person to show them that any symptoms they are experiencing are normal for their situation. If they are experiencing symptoms, then they should be told about the symptoms so that they understand their context, whether they might relate to any disorder, normalisation and so on. They need to know the context of any symptoms relating to cognitions, emotions and behaviour, along with potential problems concerning relationships at home and at work. They also need to be aware that talking about their feelings and thoughts can help them feel better, that while talking will not remove their memories, it may help them deal with their memories more effectively and live a more satisfactory life. Psychoeducation is not a matter of just handing over a document that describes common symptoms (though this is helpful), it is about talking to the individual about their feelings and thoughts, the problems they are personally having and pointing out that these thoughts and feelings are common to people who have been through such experiences.

First Interview The first interview is the main interview. It should be recorded. The aim is to cover all areas of the participant’s transition that are important to the study. If it is necessary to cover more than the transition and its surrounding elements, then NLI is probably not appropriate and NET or LSI could be used instead. The interview should normally, but not necessarily, be

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conducted in a single session which may take several hours. It can be a long process due to the need to address key behaviours, thoughts and feelings across all elements pre-, during- and post-transition. It is the detail that is important. The person will benefit most by focusing on the key negative and the key positive areas. The good points about life will help the person come to terms with the bad things that have happened. It may be that the interviewer pushes some of the positives to help the person realise that there are these positives in life. Every case is different, even within a single study. The interview is structured, the interviewer wants to cover several topics, but the course of the interview – within these constraints – is guided by the person being interviewed. Where the interviewer believes there is inadequate detail, it is important to obtain that detail through repeated questioning. This particularly applies to any trauma-related events. The interview may last several hours.

The Life Story As soon as possible after the interview, the interviewer writes up the life story. There does not necessarily need to be a full transcription of the interview, though this may be helpful. The life story should focus on the important aspects of the participant’s life story and write as much detail as appropriate. For this study, the full life story is written. It is written in the first person, so it belongs to the participant. This is an explicit means of using the double hermeneutic. The difference between this approach and other life story approaches (including NET) is that the interviewer is rewriting elements to make the story more coherent, to make sense and give meaning to what the person has said. The person’s actual words should be used as much as possible, but it is not always possible to do this fully. The interviewer needs to recognise that they may need to add words, phrases and sentences to make sense of the story. In the end, the person will own the words. Once it is written up, the life story is sent to the participant so they can address any changes they would like to see, for example, adding or deleting material, or making changes.

The Second Interview The second interview is about ensuring the life story is as complete as possible. The participant can make any desired changes (it is their story, after all). They can provide further details where necessary or where they

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think it is important. The interviewer asks about any aspect of the life story that is ambiguous or where there is a need for further detail. This might be particularly about the details regarding thoughts and feelings as these aspects are often the most difficult to obtain. Once both the person is happy with the content and the interviewer is happy that they have obtained as much detail as appropriate, the interview is terminated. The interviewer then completes the write up of the story and sends it to the person, who confirms the accuracy of the story by signing it off. The signature will need to be witnessed by the interviewer if the transcript is to be used in evidence.

Checking and Reassessment When a person has been interviewed in such detail about such difficult personal issues, it is essential that the interviewer contacts them afterwards, perhaps a few days later, to see how they are. Usually the person feels much better, but there is a possibility that they will feel worse, and if so, the interviewer must provide guidance for further help. This will already have been provided on an information sheet but sometimes it is better reinforced by the interviewer. The NLI usually requires a person is reassessed on the same measures as the start of the process, and sometimes again some months later, to determine whether any changes occur as a result of the NLI. Of course, in order to determine whether any changes are a result of the NLI or the simple result of the elapse of time would need a randomised controlled trial, but that is outside the scope of this book. I will look at two examples from our own research to illustrate the NLI, refugees and transsexuality.

Refugees In the case of refugees, it is necessary to look at the participant’s life before becoming an asylum seeker, the incidents relating to why they became an asylum seeker, details of life when seeking asylum and their experiences in the host country (the UK). It is essential to examine the individual’s behaviours, thoughts, feelings and emotions throughout the relevant period. There is a clear transition which can have a significant effect on the individual, from the home country to the host country. The example is that of three refugees who relatively recently arrived in the UK after harrowing experiences in their home countries. The potential

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benefits of enabling people to tell their story in detail justify the development of this new technique of obtaining life interviews. For the example given here, there is no attempt to determine whether there is symptom reduction as a result of using the technique. That would require a larger study. The key aim at this point is to examine the protocol. The refugees were subjected to detailed questioning about their experiences and about associated behaviours, thoughts and emotions using NET-style questioning. The resulting transcripts were analysed using IPA (Smith, 2011). The process of developing the story jointly was beneficial for the refugees in enabling them to develop a coherent story about their experiences, and all refugees indicated that they found the process beneficial, but this is just based on comments. Future research will examine the impact of the NLI in reducing symptoms of trauma and anxiety, and in looking at different populations.

Method Participants Three refugees took part in the study. They recently arrived in the UK from various home countries. Their details are listed in Table 6.1. The three refugees all agreed to take part in the study. All were provided with a participant information sheet and signed a consent form. The interviews all took place in a private room in a refugee centre. The project was ethically approved by the Faculty of Medicine and Health Ethics Committee at the University of Nottingham. Interview Protocol The interview protocol focuses on the key aspects of the participants’ lives, particularly their lives in their home country, the transition to the UK and life in the UK, including full details of behaviours, thoughts and emotions. The initial questions are few but open, relying on the experience and skills Table 6.1  Participants Person

Age

Home country Length of time in UK (years)

A (Female) B (Male) C (Male)

52 38 24

Iran Saudi Arabia Syria

1 2 2

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of the interviewer to obtain sufficient relevant detail, as each participant’s experiences will be different. The questions for the NLI have both a general focus (e.g. on behaviour, cognitions and emotions) that relate to all NLI interviews and are generally used as prompts, and questions that are specific to the people being interviewed. For the purposes of this study, the key specific questions include: – What was your life like in your home country? ◦ Describe key events and people. – What was it that led you to seek asylum? – Describe what happened when you moved from your home country to the UK. ◦ Full details, include behaviour, thoughts and feelings (including the behaviour, thoughts and feelings regarding other key people) – Describe your reception in the UK. – Describe your life now. The following prompt applies to all the key questions: ◦ Full details, include behaviour, thoughts and feelings (including the behaviour, thoughts and feelings regarding other key people) The participant is asked at the beginning to answer questions in as much detail as they can. The interviewer must be flexible regarding the actual questions, as these will depend on the individual’s responses. Interview Procedure This followed the procedure described above, with the interviewer writing out the participant’s life story between the two interviews. It is critical that the interviewer has good interviewing skills, that they are active listeners and can ask open-ended questions, the format of which depends on the participants’ previous responses. It is essential that there is a level of trust and rapport between the interviewer and the participant. Analytic Procedure This is a practical problem that arises when employing narrative approaches. There are several approaches to use when employing narratives. The approach that is used depends on the purposes of the research. As indicated, IPA is a useful analysis when examining certain types of

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narratives, as it examines the unique experiences of the participants’ lives, and explicitly recognises the double hermeneutic, the way in which a person is interpreting their life and the way in which the interviewer is trying to interpret that interpretation, which is critical to NLI as the method of producing the final transcript explicitly draws on the memories of the participant and the expertise of the interviewer. The NLI can use different techniques of analysis, but a combination of narrative, describing the person’s life in some detail to examine some of the potential causal elements relating to their experiences of the transition, and then employing IPA to dig deeper into understanding their lives, their choices and their responses, provides a detailed account of individual lives. This is why an NLI study which is focusing on research rather than therapy will inevitably have a small number of participants; the individual experience is critical. Results The three refugees came from varying backgrounds and had different experiences of becoming a refugee. The IPA focused on two key areas. The first examined the practical experiences of home-transition-uk. The second on memory, emotions and coping. The details of the first are described below in the life stories of the participants. This is an example of storytelling rather than story analysis. Narratives of the Refugees (Storytelling) A52F is a 52-year-old female from Iran. Her family was involved in revolutionary politics before the Shah was deposed in the revolution of 1979. Her own involvement in politics after the revolution was one of the reasons she was imprisoned. The other was that she wanted to convert from Islam to Christianity. In prison, she was treated very badly. She was beaten, there was no safety, it was dirty and guards threatened to kill her. She remembers that time vividly; it is a film that plays in front of her. She describes the horrors of Sharia Law as it is applied in Iran. A woman who renounces Islam will be tortured, possibly raped and stoned to death. She witnessed a stoning. A woman who had sex with someone who was not her husband. She describes the blood and how she had bad dreams about it. She came to the UK via Turkey and possibly Bosnia. It took several months and she did not have control of the process. She arrived in the UK unable to speak English and was put in a dirty hotel. Fortunately, other people who had been asylum seekers helped her, sometimes Iranians, who provided her with clothes

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and money. She received no psychological support. Her identity is mixed, though she has integrated into UK culture. She has mixed feelings about being in the UK, still missing Iran. Culturally, she cooks Iranian food, but also food from all cultures. She volunteers for the asylum network and is very happy with the work and the network. She sees herself as both British and Iranian, and British people treat her well. She is happy with her mixed identity. Her life has changed a lot but she has a positive outlook for the future. She is now a Christian and a Labour Party supporter. B38M is a 38-year-old male from Iran, who has only been in the UK for around 2 years. He was born to a family that ruled a sultanate until 1967, when it was taken over by Saudi Arabia. In Saudi Arabia, he did not have a real identity and though he worked there for many years, he became effectively stateless, the Saudi government would not give him a passport, which is why he decided to move to the UK and claim asylum. His journey to the UK was a plane flight. At the time of the interview, he does not have the Right to Remain as the UK government has not accepted proof that he is stateless. The refugee centre has been very helpful legally and in terms of social support. He is not allowed to work but has volunteered as a translator. He had never been in prison in Saudi Arabia but after living in a hostel for some time, he was put in a detention centre in the UK because the UK government rejected his asylum claim. He was eventually released on bail but still has to report every week. He is appealing the case with the support of the asylum centre. He does not feel safe, though he feels supported. He has had no difficulties integrating in UK culture, though continues with Saudi traditions such as cooking. He left behind a woman he wanted to marry. Her family would not let her marry him, and he regrets this. He is still a practicing Muslim, but is not strictly observant. He supports freedom and human rights and hopes that Saudi Arabia will become a more open society. C24M is a 24-year-old male from Syria, who has been through many horrific experiences in Syria before escaping and eventually finding his way to the UK. As a child, he played football and swam at the highest levels, worked as a metal worker and ran his own business. He was arrested before the revolution and questioned regarding his knowledge of the opposition. Later, he was shot in the knee before being arrested again. A friend was also shot. He was beaten while on the ground with his wound, then taken to the hospital, again being beaten unconscious. The medical staff tried to protect him by pretending he was still unconscious, but after a few days, an officer stood on his knee. They then beat him, took him to prison and tortured him. He was in a cell with two friends. One was ill but no help was provided and he died. His body remained in the cell for 2 days.

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He remembers the torturer very well, down to the last detail of his tattoos. He was returned to the hospital. There was an explosion and he escaped, but shortly afterwards was rearrested and sent back to jail. More torture, for example, being hung from a wall by his wrists, being beaten with soft steel, electrocution. Now he was alone in a cell, not knowing whether it was day or night. There was little to eat, for example, half an egg one day then nothing the next. Another torture, hands tied behind his back and kicked down a slope; or dropping him in a tank of water until he struggled, then bringing him out again. There was little sleep. He wanted to die. He saw a child tortured and killed to make his father speak. Then they brought the man’s daughters to the prison and raped them in front of him, in front of all the 110 prisoners. The father was forced to watch. Eventually, a ranking officer paid to help him escape. He went to Jordan, then to Libya for 2 years, then crossed the Mediterranean by sea. The boat sank and he swam to get help. He went via Italy, France and Calais and crossed to the UK by refrigerated lorry. In the UK, he was in a hostel and then a detention centre, with the threat of deportation to Italy. He was eventually released. He is still badly affected by his experiences; bad dreams, inability to sleep properly, no coping mechanisms, poor memory, physical pain from the torture. The main thing is the loss of the feeling of being comfortable. He still regrets not dying in the prison. He is integrating into UK culture, but there is a language barrier and he missed Syria. He sees himself as having a mixed identity, British and Syrian. He is a Muslim, believes in human rights and is against Assad in Syria. Brief Analysis (Story Analysis) The analysis explored the psychological responses of the participants to the experiences described above, focusing on the transition and its impact. The participants did not just have difficulty coping with the memories of events in the home country and the difficult journey to the UK but a key aspect of why they may have problems with their traumatic memories is the way they are treated in the host country. We have found this before (Hunt & Gekenyi, 2003) with Bosnian refugees who were experiencing traumatic symptoms at least in part due to their being in the UK where there is a fundamentally different culture, with different foods, language and climate and without the support network that is often available in the home country. There were similar results here, with some of the major difficulties relating to language and culture, which were eased in all cases by the experiences with the refugee centre they all attended. This positive experience at the refugee centre was

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emphasised by all three participants, how the centre had helped practically and emotionally. While the study did not explicitly examine symptoms of post-traumatic stress disorder (PTSD) or other problems, the responses of all three participants after the NLI was completed were positive regarding how they felt better for having told their stories in this way. The Experience of Being Trans This pilot study (Holmes, 2022) concerns the experiences of people who are transsexual or transgender, that is, they identify as not being of their genetic sex – not sex assigned at birth, that is a meaningless concept used by certain groups as a political statement. Sex is determined at conception. This is an example of how it is important to establish the nature of the concepts that are being discussed. While the people in this group all identify as a gender that is not the same as their sex, they do not all identify as the opposite gender. Participants Six participants took part. All were aged between 18 and 22 years, which is important for the study as, being such young adults, they may still be in the process of building their life narratives. When asked to describe their gender, they all used a range of terms such as transmasculine and transfeminine to describe both binary and non-binary transgender people transitioning from female to either male or a more masculine gender and presentation, and from male to either female or a more feminine gender and presentation. There are important implications for personal and master narratives around gender. The Questions The questions focused on participants’ experiences as a trans/non-binary person, that is, their gender story so far. This included exploring important moments in that story, considering whether there are further milestones in the story (e.g. surgical transition), particularly positive and negative experiences, and questions around how identity and the sense of self have changed. Findings The final transcripts were analysed using IPA. Rather than discuss each person as an individual, there were several issues raised that are relevant

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for the study of narrative. Taken together, there was a single overarching theme of ‘transmedical narrative’, which refers to the experiences of the participants as transgender and non-binary. Participants highlighted how trans people are not taken seriously, even by other trans people, unless they are certain types of transgender. For instance, if a trans man wants to retain a sense of femininity or a trans woman a sense of masculinity, then they are not taken seriously. The master narrative of trans has already – even though the topic has only been mainstream for a short while – developed expectations of what is right and wrong about trans, that is, transnormativity. The normative is to go from male to female or vice versa, not ‘somewhere inbetween’. The term transmedicalism arose due to the importance of legitimacy in the eyes of medical professionals who deal with gender dysphoria. Other recurring ideas include the idea of ‘being born in the wrong body’, and wanting the bodily features and functions of the opposite sex. Nevertheless, participants discussed gender fluidity, genders which do not fit into binary ideas of male and female. They wanted a label, but didn’t believe one existed: ‘I don’t think there is ever going to be a word that can truly represent how my gender feels … gender is different for everyone’. Another element of the transmedical master narrative is conformity to the stereotypical interests and features of the opposite binary gender to the person’s biological sex. A final feature is the desire to completely medically transition from one binary gender to the other, usually driven by distressing experiences of gender incongruence that was medically diagnosed as gender dysphoria. This is not a desire everyone felt, with one non-binary participant suggesting they would like to alleviate their dysphoria through social transition rather than medical intervention. Not all the participants fitted neatly into any category, perhaps as a function of their still developing their life narratives. Several stated they still have concerns about their identity status, masculine, feminine, nonbinary. One stated that they are ‘not trans enough to get hormones’, indicating the problems faced in establishing a clear gender identity, perhaps a reflection of the strength of the master narrative, built on clear biological sex differentiation, that there are two sexes which correlate almost perfectly with two genders, male and female. It is very difficult to challenge this master narrative, because not only is it built on social differentiation, but also it is built on biological differentiation, and the numbers of people who do not conform, either socially or biologically, are minute within the population, so society has had little or no preparation for the discussions that are now taking place regarding sex and gender.

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While the NLI is a useful tool for dealing with transition, the example of trans-people is different to that of the refugees described above, as they are not all at the end of the transformation of their gender identity. While we cannot be certain, it is likely that several of them will continue to undergo the transition, and it is not possible at this stage to determine which of them, if any, have completed the transition. This may be a problem because we need to study the transition, but there is no reason why we cannot study the transition while it is still underway. In some ways, this provides a more direct and immediate insight into the experience of the transition, though it lacks the wisdom of reflecting on the transition.

Conclusions This chapter has briefly considered two forms of the narrative interview. There are others, and the choice will depend on the purpose of the interview. McAdams’ life interview has been used for many years and there is a lot of evidence to support its value. When used in conjunction with analyses focusing on concepts such as redemption and contamination, it is an extremely valuable tool. Beyond that, simply as a way of getting someone to discuss the main aspects of their life as a whole, it is invaluable. If we ask someone to describe their life, they are likely to get stuck because they have to work out the structure and decide what is important and what is not important. McAdams’ life interview provides this structure. The NLI is a new technique that has not been fully tested, but pilot work has indicated its utility for research purposes that involve examining transitions in people’s lives. The analysis shows how it is relatively straightforward to obtain detailed information about a person’s experiences using this technique. The key elements include (a) providing a structured approach to obtaining transitional information, (b) explicitly focusing on the detail of cognitions and emotions and (c) the potential therapeutic benefits. The therapeutic benefits of NLI are as yet unproven, but the responses of the participants and the use of the NET technique of detailed narrative interviewing regarding emotions and cognitions are positive for further examination in future studies. Both forms of interview are available and can be used for a variety of purposes. Narrative researchers do need to consider the structure of their interviews and ensure that they will serve the purpose that is intended. Interviewing for narrative is not the same as a general qualitative interview.

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Chapter 7

Narrative Writing

Many of us do narrative writing. Some of us write a diary or journal about our lives. This may range from a list of dates and events – which is not really narrative writing – to detailed expositions of the events of the day – which is narrative writing or autobiography. Blogs, social media, emails or webpages can be examples of narrative writing, so can books and shorter accounts (e.g. short stories), both non-fiction and fiction. Published narratives are the more formal end of narrative writing. Narrative writing is used in psychotherapy. An individual may be asked to keep a diary of their thoughts and feelings – perhaps relating to aspects of their perceived problem. Narrative writing is also used in a specifically therapeutic manner, as we shall see later. People who have been through difficult times often feel they benefit from writing about it, whether informally – perhaps with no intention of anyone else seeing what they have written, that is, the writing itself is therapeutic, or formally – through books or articles. Some people who have been through a difficult time write a book about it. After a war, there is always a surge of publications about that war written by the participants. Writing itself appears to be therapeutic, this is partly because it takes time to construct the sentences the person wants to say, which enables a more thoroughly thought-out account than when one is just talking about it, and partly because it is storymaking. Writing as therapy is not new, its capacity to reduce tension in patients was described as early as the eighteenth century (McKinney, 1976) and commonly used throughout the twentieth century in combination with spoken psychotherapy (Riordan, 1996). It has various names – expressive writing (e.g. Smyth & Pennebaker, 2008), written emotional disclosure (e.g. Frisina, Borod & Lepore, 2004), scriptotherapy (e.g. Riordan, 1996) and therapeutic writing (e.g. Wright & Chung, 2001). All involve writing freely about a topic or event without paying attention to grammar or spelling. It is highly time-efficient, and low cost because often the therapist is 91

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not directly involved (Smyth & Helm, 2003). Writing is a promising intervention in online therapy (Wright, 2002b). It can be offered in combination with traditional therapy, for example, a written reflection of therapy sessions (Riordan, 1996) or some other form of homework that may or may not be examined in therapy sessions. Writing may offer rich information to track mechanisms of therapeutic change (Cummings et al., 2014). The literature is mixed regarding the effectiveness of writing, though Bolton et al. (2006) were confident enough to produce a resource handbook for therapeutic writing, and such writing is certainly growing in popularity, at least among some therapists.

Expressive Writing Perhaps the best-known technique of therapeutic writing is Pennebaker’s expressive writing. Jim Pennebaker has conducted research in the area for several decades (e.g. Pennebaker, 2018; Pennebaker & Beall, 1986; Pennebaker & Seagel, 1999). Several specific techniques have been tested, but the basic protocol involves a person writing anything they like about a subject for 20 minutes on three separate occasions, usually on three consecutive days. The writing is then destroyed. It is important – according to Pennebaker – that it is not read by anyone. This ensures that people are free to write whatever they wish, and it will not be judged by anyone, yet it will, it is hoped, still have a significant health benefit. The original paradigm was to use college students as participants, have three writing sessions and write about a personal stressful event or a neutral event. There were no further specifications, though later studies changed the gap between writing sessions and the timing, perhaps with additional sessions spread over more days. Those in the expressive writing condition tended to report fewer doctors’ visits and fewer physical complaints (Pennebaker & Beall, 1986) compared with controls. Later studies had more specific instructions and focused on specific topics such as cancer or divorce. Several randomised controlled trials (RCTs) have suggesting examining the efficacy of expressive writing, with mixed results. For instance, Zachariae and O’Toole (2015) examined it with cancer patients. While they did not find any significant benefits, they did suggest that small effects with particular subgroups of patients could be clinically relevant. This is an important point. While there may not be benefits for everyone, there may be benefits for some, and the technique is cheap and easy to administer, so is probably worth trying. The difficulty is choosing those who will benefit. What are their characteristics, and after what kinds of

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events might they experience positive change? Individual difference factors are important and have rarely been studied. This is not specific to expressive writing, most of the research into other therapeutic techniques has ignored individual characteristics that might predict when the technique is going to work. For any of these techniques, using them with the wrong person may be psychologically damaging, so there is a good reason to ­conduct such research. Many of the studies have been conducted with students, and they often demonstrate that writing itself can significantly reduce levels of stress and increase well-being. Meta-analyses over the years indicate some positive effect of expressive writing (Pennebaker, 2018). These positive findings are far from universal, and this is why people have tried different forms of the technique to make it more effective. Expressive writing can be a supplement to psychotherapy, presumably also a replacement for those with less severe problems. It is particularly interesting that it has an impact not only on mental health but also physical health.

Why Might Expressive Writing Work? In the 1980s, Pennebaker had a working theory that secrets were toxic, that they were a form of active inhibition, which entails concealing and holding back emotions, thoughts and behaviours. According to Pennebaker, this is in itself stressful, and such long-term low-level stress could influence immune function and physical health. Expressive writing with the destruction of that writing should be used because revealing secrets to other people may have complications, so it makes sense to use writing instead. Later, Pennebaker et al. (2007) proposed that writing is a window into cognitive and emotional processes and personal identity, and that writing about deep and personal issues can promote positive individual and psychological health (Pennebaker & Chung, 2011). Emotional inhibition, cognitive adaptation and exposure/emotional processing have all been theorised to explain the physiological and psychosocial results seen in expressive writing studies (Sloan et al., 2008). Pennebaker and Graybeal (2001) suggest that expressive writing creates opportunities for people to rehearse social behaviours that result in greater connectedness. Cognitive change helps people understand themselves better and see things in a new and different way by creating a coherent story of the event (Pennebaker et al., 2000). In the end, the mechanism by which expressive writing operates may be complex and not accounted for by any one theory (Sloan et al., 2008), which is why, when we have no real

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evidence for a particular theory, the general lesson is that we should not trust theories that do not have empirical support. Instead, we should be testing them. Various researchers, including Pennebaker himself, have adapted the expressive writing protocol in several ways, including writing for longer, writing in response to specific questions, changing the number of times or the time period writing takes place and various other techniques. Researchers have attempted to analyse the content of the writing to see whether specific words, phrases or ideas are more effective at reducing stress in participant. Again, the findings are ambiguous. Frattaroli (2006) examined potential moderators that could explain the conditions under which expressive writing is most effective, including more sessions, longer sessions and more directive instructions. He found no effect for spacing between writing sessions, valence of topics and focus of disclosure instructions (general vs. specific). The protocol tended to work best for physical health outcomes rather than mental health, though depression showed a small but significant effect. Reinhold et al. (2018) conducted a meta-analysis to determine whether expressive writing reduces depressive symptoms. Thirty-nine RCTs showed that general expressive writing did not yield significant long-term effects on depressive symptoms, but effects were present when there were more sessions and the writing topic was specific. It was also more successful with specific populations. They propose longer directed writing interventions with additional therapeutic support. Rubin et al. (2020) argued that the efficacy of expressive writing for bereavement remains unclear, though some evidence suggests that writing about positive memories of a loved one may be beneficial. They found no main effect of the positive writing condition on mood change, but there was a greater positive emotion using mediated positive affect among those in the positive writing condition. Craft et al. (2013) examined expressive writing and quality of life in early breast cancer survivors. Participants wrote for 20 minutes a day for 4 days. This included focused instructions on writing about one’s life to help deal with a diagnosis of breast cancer. This approach was recommended for survivors as a feasible and easily implemented treatment to improve quality of life. Mordechay et al. (2019), using the expressive writing paradigm, had an experimental group write about emotion-laden experiences, while a control group wrote about everyday events. Both groups were measured on the Impact of Events Scale (IES), which measures post-traumatic stress symptoms, and the Brief Symptom Inventory (BSI), which measures

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psychological distress. There were greater reductions in IES for the experimental group. Those with higher severity on the BSI had greater reductions. Those with high neuroticism experienced greater benefit, that is, those with more negative feelings gain the most from expressive writing. Zachariae and O’Toole (2015) evaluated the effectiveness of an expressive writing intervention for improving psychological and physical health in cancer patients and survivors. They reviewed sixteen RCTs. The results did not support the general effectiveness of expressive writing in cancer patients and survivors, though given it is practical and inexpensive, even small effects could be clinically relevant. They recommended that researchers should test moderators, including pre-intervention distress levels and context-dependent factors such as emotional support, when assessing effectiveness. Overall, the findings regarding expressive writing are – as stated by several researchers – mixed. It sometimes works, it sometimes does not work. Why is this? It may be the selection of participants. It seems likely that writing will work for some people but not for others, and researchers need to find ways to select the people for whom it will work. There is little point in asking everyone to do expressive writing if it is not going to have a positive effect. Indeed, for some, it may have a negative effect, making them feel worse rather than better.

LIWC LIWC (Linguistic Inquiry and Word Count) is a computer programme designed by Pennebaker that has been used to analyse the content of writings produced using the expressive writing paradigm. It does not carry out a narrative analysis, but it does count the number of times particular words have been used and can help group these words into categories. There are around 80 different groups that relate to linguistic, psychological and topical categories including ones related to various social, cognitive and affective processes; so it is possible to use LIWC to ascertain the percentage of, for example, negative emotions. Stockton et al. (2014) conducted a study on post-traumatic growth using internet-based expressive writing. Participants wrote for 15 minutes on three occasions 3 days apart. Post-traumatic growth significantly increased from baseline to an 8-week follow-up in the expressive writing group, but not for the controls. Analysis of language use using LIWC showed a greater use of insight words associated with an increase in post-traumatic growth. These findings have implications for internet-administered expressive writing.

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Allgood et al. (2020) used LIWC and found a relationship between marital satisfaction and the use of (a) first-person plural pronouns (we, us, our, ours), (b) positive affective language and (c) linguistic indicators of anger when writing about one’s relationship. Gottman and Gottman (2008) examined the relationship between marital satisfaction and expressive writing. They emphasised the importance of couples enhancing their understanding of each other. Couples develop an intricate love map of one another, which allows them to understand and empathize with each other’s experience. The down-regulation of negative affect is important, as is the up-regulation of positive emotions. A comparison of the use of LIWC versus in-person analysis (Landless et al., 2019) indicated that while the computer-based analysis is quicker than human analysis, it lacked the richness and nuance that people brought to the analysis. Furnes and Dysvik (2012) examined therapeutic writing and chronic pain management, using writing as a tool for managing difficult life experiences. Thirty four outpatients were given an 8 week pain management programme. A therapeutic writing tool was developed and included as homework. A thematic analysis demonstrated the patients had an increased understanding of chronic pain as a multi-faceted experience and new insights into managing chronic pain. Different performances lead to different experiences with therapeutic writing. This is a useful finding as there are only limited medical ways in which chronic non-malignant pain can be treated, so we need other ways to manage it. This is an important finding as it suggests that writing can not only be used for specifically psychological problems but also for the use of indirect psychological problems such as pain management. In response to Furnes and Dysvik, Kelly (2014) said that it is hard to resist the speculation that there are few among us who would volunteer for the personal hardship of writing and that recruiting people to conduct some writing tasks would be an exercise in futility. Nevertheless, the Furnes and Dysvik findings suggest it works, which shows the importance of writing, at least for some people. It is not clear what proportion of the population can write in this way, do so and gain some benefit from it. It may just be the select few who benefit.

Narrative Writing Generally There are other ways in which writing as therapy has been developed and used. There are many different clinical interventions, such as journaling, creative writing, reading literature or performing poetry (e.g. Alexander et al., 2016; Mazza, 2003). Boulay et al. (2020) conducted a systematic

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literature review using writing in therapeutic settings with adolescents. This showed there were positive effects of writing practices in both cognitivebehavioural and psychodynamic settings. Sargunaraj et al. (2021) reported a case report using therapeutic writing as an adjunct to psychotherapy. A period of thirty writing sessions and seventeen in-person sessions were held with a person with long history of emotionally unstable personality disorder and socio-occupational dysfunction. They showed improvement after therapy. Therapeutic writing shows promise as an adjunct to psychotherapy in addressing emotion regulation. Ramsey-Wade et al. (2021) presented a systematic review of twelve studies that assessed whether therapeutic writing could improve outcomes for clients with disordered eating. The studies were mainly high to moderate quality quantitative studies, with a positive trend for therapeutic writing, indicating it may improve outcome for clients. Qualitative results indicate writing interventions can access a depth of emotional experience. They concluded that writing is useful to enhance emotional expression or group cohesion. Den Elzen (2020) use of therapeutic writing in psychotherapy through the lens of the grief memoir. This technique draws on expressive writing and links autobiographical writing to dialogical self theory. It identifies how the authors voice subject positions such as the bereaved self and the remembered other and how writing positions and repositions such selves to facilitate the rebuilding of identify disrupted by loss and recovery from grief. Overall, the research suggests there may be benefits to writing as therapy.

Writing in Groups Group writing can be beneficial. A group can provide support where the person is involved with writing about difficult, perhaps emotional, subjects. Groups can be run by therapists, counsellors or other health professionals, writing tutors or they may be a formal or informal writing group. There are no limits on writing in groups. Sometimes people read out their work for comment and discussion, sometimes they don’t. Sometimes the therapist will see the writing, sometimes they won’t. Tutors and therapists can help people get over writers’ block.

Possible Problems with Narrative Writing While writing can be illuminating and helpful, it can also be potentially dangerous. It is not always a good thing to bring problems out into the open. While some narrative writing is done in conjunction with others,

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whether with therapists or other health professionals, or groups, some, perhaps most, writing is done alone. This can be a problem if the writing brings out difficult, perhaps emotional, issues that the person cannot find a way to resolve. Who do they turn to? We like to think we have control over our writing, trying to understand the way our minds are working, but this can be destructive. We are often our most severe critic, and may draw conclusions that are not helpful. Landless et al. (2019) suggest that therapeutic writing benefits both physical health and emotional well-being. They examined the usefulness of clinical notes as a data source. Many participants reported therapeutic writing as helpful, a relevant coping skill and enjoyable. Other participants preferred to work on other tasks in the art therapy sessions, indicating that writing benefits only certain people. Sloan and Marx (2018) said that we have consistently seen how expressive writing can be useful, but research in the area has suffered from a lack of systematic focus and a weak theoretical foundation. Nevertheless, it is a useful clinical tool, though clinicians need to be thoughtful about when and why expressive writing is integrated into clinical care. Another problem for expressive writing and therapeutic writing in general is that we must take individual differences into account. Many studies have just put people into groups irrespective of individual characteristics, and it is inevitable that while some people may experience benefits from writing, others may experience either no benefits or negative outcomes. Few studies have taken this into account. Why does writing work for some people and not for others? Who does it work for? Are there tests we could administer that will help us differentiate who it will work for? Would it be as simple as asking someone if they liked writing about themselves and their feelings?

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Chapter 8

Narrative Therapy

If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment. Marcus Aurelius

The only way a talking therapy can hope to have any success is by changing a person’s story, by changing the way they think about themselves. In order for this to happen, the person must recognise there is a problem, they must want to do something about and accept – at least at some level – that another person, the therapist, might be able to help them. If they thought they could help themselves, they would not need the therapist. This applies to any form of talking therapy, including narrative therapy. The biggest problem with narrative therapy is that it is carried out in many different ways, which immediately raises the problem that if we do not have a definition and clear set of guidelines, then it becomes difficult to use effectively and, most importantly for an applied method, difficult to assess for scientific utility. This is not a problem unique to narrative therapy. It can be argued it applies to all forms of talking therapy (cognitive behaviour therapy (CBT), psychoanalysis, etc.) because each therapist–patient relationship is different, and each session is different, with different forms of communication and interactions. The original form of narrative therapy, which has been used for around 30 years, was introduced by Michael White and David Epston, but there are a multitude of other narrative forms which can be labelled as forms of narrative therapy (Brown & Augusta-Scott, 2007; Freedman & Combs, 1996; Strong & Pare, 2004, White 2004). Some of these are built on White and Epstein’s work, while others differ significantly, building in new elements such as dialogical perspectives (Hermans & Dimaggio 2004; Lysaker & Lysaker, 2006; Osatuke & Stiles, 2006). This chapter 99

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will focus mainly on White and Epstein’s work and its developments as it is the original and most studied, though the level of evidence is, as we shall see, rather weak. Narrative therapy is based on poststructuralist philosophy (Foucault, 1980; White 2000), in opposition to structuralism, where we assume structures are real things, and we look for underlying structures and universal laws. Regarding therapy, structuralism assumes that we study people as individuals with essentially stable characteristics that can be grouped and graded according to universally applicable norms, such as the mental disorders classified in Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD). Poststructuralist narrative therapists focus on contextualised meaning rather than universal truths. People’s lives and experiences are shaped by their stories, but these are not purely individual constructions; in any social group, we all participate in each other’s stories. As we saw in the chapter on master narratives, we all participate in society’s discourses. For Hare-Mustin (1994), discourse is ‘a system of statements, practices, and institutional structures that share common values’ and ‘discourses bring certain phenomena into sight and obscure other phenomena. The ways most people in a society hold, talk about, and act on a common shared viewpoint are part of and sustain the prevailing discourses’ (pp. 19–20). The norms of a culture are often taken for granted but do change over time. For example, it was long held that a man should earn more than a woman. If a woman earns more, both may think something is wrong with their relationship. We may reproduce these discourses in therapy without thinking about it, automatically, implicitly. It is not something we generally have much control over. The relationship between the individual and the social world also has implications for power and power relations. Foucault (1980) used the term ‘modern power’, arguing that traditional power comes from some central authority (king, dictator, etc.) and is enforced through often violent authority, prison, torture, floggings, executions, etc. Modern power is more pervasive; it is carried in discourses. At the central level, this might be through lobbying, advertising or the media. Modern power helps us police ourselves, which means that we don’t usually notice the power of modern power. There are standard ideas about how to behave, from what we buy to eat or wear to voting for democratic parties. Most of us tend to live up to the dominant discourses and norms in society, we compare ourselves to what is deemed good, normal and successful. This also applies to people undergoing therapy. Once they learn to look for how they are influenced by modern power, they can question its influence and perhaps change the

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way they look at aspects of the world, change their life stories. According to White (2002), modern power, used well, can unsettle what is settled or taken for granted, and provides new avenues of inquiry. This unsettling is part of the ethos of narrative therapy. As already mentioned, the focus of this chapter is on the approach of White and Epston and how narrative therapy has developed from their early writings. A word of caution, there are certain areas in psychology where people provide a new means of trying to understand an area of psychology, often with a practical element that claims to provide a solution to some problem. At the outset, there may be grand claims about the effectiveness of these techniques. For some areas, the evidence eventually becomes clear that there is some real benefit or real understanding, and it becomes mainstream. For others, there is an element of the cult around it. Those who proclaim its benefits are somewhat like priests, proclaiming the benefits of a religion without a shred of evidence. Many areas are, of course, somewhere in the middle, where there is some evidence of effectiveness, but it is limited, though supporters may continue to shout from the rooftops about its benefits. Homeopathy is a good example of an area where the science suggests there is no real benefit (whatever the sellers of these miniscule substances might claim). Freudian psychology is a theoretical area which has limited support in the scientific literature yet continues to be popular. Eye movement desensitisation and reprocessing (EMDR) is a form of treatment for post-traumatic stress disorder (PTSD) which initially was seen as somewhat off the wall but has since developed a good scientific basis. What of narrative therapy? According to White and Epstein, narrative therapy is used to evaluate discourse, clients’ thoughts and behaviours in the contexts of their cultures and social environments with regard to the stories they have constructed. It is about re-authoring lives, fundamentally changing people’s perspectives, life stories, for the better; but there is no judgement regarding the initial life story, about why it might be good or bad, nor is there a judgement by the therapist regarding the new story. Whether or not there is improvement is the decision of the person undergoing therapy. This is a problem. The standard method of assessing the effectiveness of a therapy requires, first, that there is a recognised measurable problem (normally defined by ICD or DSM) and second that there is a recognised definable therapy. We can measure the problem before and after and see if there is a positive change. People undergoing narrative therapy do not always have a recognised measurable problem and so it can be difficult to measure the effectiveness of the therapy. We need other means.

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People cannot always be categorised in terms of the DSM/ICD categories. Narrative therapists tend to have a problem with this form of categorisation, preferring instead to have a conversation so the client can determine the problem. DSM/ICD categories can be a problem of fitting a round peg into a square hole. This is an advantage of narrative therapy, the therapist is not trying to force a person into a diagnosis of a mental disorder. Of course, the difficulty that then arises is that it becomes more difficult to assess the efficacy of the therapy, except in terms of whether the client believes the problem has been resolved or at least that there is some form of clinical improvement, however defined. This may be the point to differentiate among mental health problems. There is a political tendency to classify all mental health problems as being of a similar severity. Not only are they politically ‘classifiable’, but each should also be treated with similar care. While most people would agree that psychotic problems such as schizophrenia can be severe and may need medical treatment to enable the person to manage their lives, many of what we used to call neurotic problems, anxiety, depression and so forth, usually derive at least in part from the interaction between the person and the environment and may be resolvable through psychotherapy. The argument regarding whether many of these problems should be classified as disorders is resolved in narrative therapy simply because the notion of a classificable disorder is not central to determining what the problem is and how it can be resolved. Narrative therapy focuses on deconstructing the problems people bring to therapy, examining people’s personal values and how they help constructing new productive stories. It is like coaching clients to realise what they want to accomplish and getting them to the point of change by making them decide what change they want.

What Are the Problems Clients Face? But what changes do the clients of narrative therapists want? Why do they want narrative therapy? If there is a problem with the medicalised classification of disorders, there still needs to be a recognisable problem that needs to be resolved. Perhaps the best way to deal with this is to draw on current practice in clinical psychology and use formulation rather than diagnosis. Richert (2006) argues that the therapeutic alliance might be improved and an integrative use of different theories might be made by selecting therapeutic approaches and interventions based on the similarity between the nature of the client’s life story and the story of human

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functioning incorporated in the theory, a kind of formulation approach for narrative therapy. The initial stage of narrative therapy is, just the same as in other forms of therapy, determining exactly what the problem is, a clear diagnosis or formulation of the problem as the client sees it. That will provide the substance that the therapist can work with. It is the story that the client wants to change, the basis for deciding how narrative therapy can be used in this instance. One advantage of narrative therapy is that it acknowledges that people present with different problems, and it can be difficult to group problems together into an overall classification (as required by ICD/DSM). This advantage can become a disadvantage for establishing evidence for efficacy.

What Is Narrative Therapy? The term narrative therapy may be employed loosely to describe any approach that encourages people to tell or restructure their story. At one extreme, all talking therapy is narrative therapy because it is intended to help people make sense of their lives and the events in their lives. This is back to the argument that much general psychology is narrative or has narrative elements. Applied psychology is about trying to make people’s lives a little better, which in turn means helping people to make better sense of their lives, or adjust their biographies to be a little happier, contented or satisfied. We are not trying to make everything perfect, just a little better than it was. While it can be argued that all talking therapy involves narrative, Richert (2006) argues that theories of psychotherapy are often cognitive constructions rather than narratives, structured in accord with the tenets of paradigmatic rather than narrative thinking. Even many that employ a phenomenological stance do not discuss the client’s reality as being structured in a narrative manner. Many are mainly rooted in a post-positivist tradition and accept a realist ontology and employ efficient causal explanatory frameworks where various forces and principles outside of the client’s phenomenal field help shape the client’s functioning. Can these be integrated into a narrative approach? Constructivism accepts multiple realities so each theory can be understood as creating a reality for its adherents. Perhaps we should look at the problem not in terms of approximation to truth but in terms of characteristics of the reality it constructs about human nature, causation and behaviour change. In this sense, even fundamentally paradigmatic approaches can be considered as highly abstract stories about reality.

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Getting the Story, Understanding the Problem Clients bring stories of their lives to psychotherapy. In narrative, clients transform themselves by changing the stories they tell about their lives. There is always context, the context of other people, the environment, work, leisure activities. This context is always changing, and so the stories people tell are also always changing. One problem is that sometimes life events resist storytelling (Guilfoyle, 2018), although turning conversion into narrative form is recommended as a therapeutic strategy, particularly for problems such as trauma, it can be a difficult and complex process. There is a danger of the emerging stories being more stories of the therapist than the client, and so may not be experientially resonant to the client. Other clients may have habits that dispose them to problem-saturated stories and negative identity conclusions. This means that the therapist may just be listening to chaos narratives (Frank, 1998). Experience and story are not the same thing (Bakhtin, 1993), it is not always easy to transform the experience into a story. A good example is when powerful experiences overwhelm our narrative capacity to contain or organise experience, leaving us lost and bewildered, without reference points and the guidance stories usually provide. Some trauma stories fragment stories and defy accommodation within culturally available narratives and categories. Narratives can only go so far to help us through challenges. The client should not be prematurely pushed towards order and meaning. Listening to difficult stories is witnessing, which is constitutive rather than just observational, contributing to the building of narrative. Frank (1998) argues there are four orientations to this witnessing: – Look, say what I see and don’t look away: initial feeling of powerlessness in relation to horror etc., reflect what you see/hear. – Historicise and legitimise the person’s experience: a person’s negative sense of self is not indicative of failure but a legitimate consequence of what they have been through. – Stand in solidarity with the person: therapist cannot be a neutral observer of events. Consider our position in society, power dynamics, what is our stance on this. – Find personal resonance while acknowledging difference. For narrative therapy to be successful, people need to identify their own skills and abilities and use these to transform their lives, their life stories, the ways they interpret the past, present and future. Morgan (2000) describes narrative therapy in several ways, particular ways of understanding identity,

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understanding problems and their effects on people’s lives, how we talk with people about their lives and problems or understanding therapeutic relationships and the ethics or politics of therapy. A narrative conversation is always interactive, it is a narrative that is developed by both participants, the client and the therapist, though it is always guided by the interests of the client. As we will see in more detail, narrative therapy has been used in a range of situations such as eating disorders (Weber et al., 2007), domestic violence (Allen, 2007) and conflict resolution (Winslade & Monk, 2000). As discussed throughout the book, our lives are dominated by stories, some more important than others, and all affected by or grounded in wider society, and cultural values relating to, for example, sex or gender, class, race or disability. With narrative therapy, we need to determine which stories are of interest to the client, what they want to talk about in relation to a problem that has arisen and particularly how stories can be changed. The important thing – again as for most types of talking therapy – is that the person must want to change, they must realise that there is a problem that needs solving and they realise that they need therapeutic help to sort this problem out. A person in need of help may have a problem-saturated story. Narrative therapy is a therapy of questions (Combs & Freedman, 2012). The primary purpose of questions is to generate experience, very different to simply gathering information. A question encourages a person to think, to come up with answers that go beyond simply providing information to the therapist. It is an essential process in narrative therapy.

Three Stages of Narrative Therapy The number of stages of narrative therapy varies according to author, but at its simplest, there are three: deconstructing problematic dominant stories, re-authoring dominant stories and remembering conversations. This takes the client through important elements of the therapeutic process. In the first element, deconstructing problematic dominant stories, the person is asked to name the problem, explore the history of the problem and its effect, to situate it in the context of the rest of the person’s life and to explore unique outcomes. This provides the context for the problem, the formulation if you like. The second element, re-authoring problematic dominant stories, is the part where the person attempts to make changes to improve the life story, through determining the best unique outcomes and looking at previously more implicit elements of their identities and their experiences. The person explores the history and meaning of the various unique outcomes

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and names an alternative story. They then thicken this story, provide it with substance, make it real and thoroughly link it to the life story generally. The final element, remembering conversations, is about ensuring the changes are not lost, that they remain, because it is difficult to sustain change. This involves collecting therapeutic documentations, exploring appropriate rituals or celebrations and engaging with support networks.

Key Components of Narrative Therapy There are a number of broader components to narrative therapy, many of which are linked, which can be subsumed under the three key elements above but they don’t always fit within a single stage and given that therapy involves going backwards and forwards through different elements, I have not attempted to over-categorise as this is rather artificial and misleading. Many of these components are the same as or similar to the components of other types of therapy, others are genuinely novel, but together they do form a fairly coherent and distinct package that is narrative therapy: – Personal agency – The problem is the problem – Externalising focus – Double listening – Examine the stories that shape a person’s identity – Thin and thick descriptions – Double listening – Dialogical disruption – Focus on unique outcomes – Maintaining a stance of curiosity, ‘not knowing’ – Asking questions you don’t know the answer to – Clients as experts – Culture and social environment – Redescription

Key Components in a Little More Detail Personal Agency Narrative therapy always recognises the centrality of the individual and the individual as the expert. Personal agency is the idea that the person is the one who causes or generates an action. Someone with personal agency will

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perceive him or herself as the one who influences their own actions and circumstances (Gallagher, 2000). The person is making decisions about their life, not the therapist. Both parties must recognise this. The choices lie with the person, not the therapist. As Morgan (2000) notes, it is only the person who knows their own life intimately and has the skills and knowledge to change their behaviour. This does not mean that we should fail to acknowledge the skills and experience of the therapist in enabling the individual to make substantive changes to their perceptions of life, to their life stories. The Problem Is the Problem According to White (2000), the person is not the problem. The problem is the problem and is separate from the person. This means we can support and help people, which is better than suggesting people are the problem. If a person is the problem, then it may be difficult to help them change. If they are separate from the problem, then it can be resolved more easily. It is important to externalise conversations to separate the person and the problem. If the latter is externalised (not part of the individual), then the therapeutic relationship is with the problem. We can then address how it can be examined. What feeds it, who benefits from it, in what settings might the problematic attitude be useful? The person is not the problem. The problem is separate and should be dealt with as such. This is not to say that the problem does not have a profound impact on the person. Of course it does, and the interaction between the person and the problem needs to be evaluated. Externalising Focus This is closely linked to the previous statement. It is important to separate the problem from the person. Externalising focus involves naming a problem to help a person see how it works and how to fix it. Externalising ensures that people see themselves as separate from the problem where the problem is no longer part of their identity or personal truth. The problem is that by the time people go for therapy, they often think they have something wrong with them, the problem is a part of them. Part of the aim of an externalising focus is to show the client that the problem is not part of them, but is linked to society and history, to the environment, to the ways they interact with the environment and other people.

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Double listening is an idea promoted by White and Epston (1990) that provides an opportunity to learn about the client from both sides, that is, what works and what doesn’t work. It is the practice of hearing a person’s dominant story while simultaneously remaining open to the possibility of other important stories that are hidden by the dominant story. It is similar to active listening but more, because it is actively looking for these hidden stories (Meyer, 2015). The Stories That Shape a Person’s Identity These are life stories. They are not about the whole of life, which is a story that can never be told in full, but about specific elements of life, such as the problems associated with a relationship, living in particular accommodation, having a certain job or going through some form of important transition such as having a baby, getting married or becoming unemployed. Life stories about events are different to life stories about transition. It is important that life stories for narrative therapy are about transition. They are not just about the description of a particular life event, but the impact that life event has on one’s thoughts, behaviour and emotions. Having a baby is about the initial decision (or not) to have a child, the experience of pregnancy, birth and learning to live with an infant. It is the transition from not having a child to having a child. Narrative therapy deals with problems associated with transition. Thin and Thick Descriptions We often start with what narrative therapists call a ‘thin description’ of a particular problem. For instance, the almost throwaway descriptions we have of ourselves or others and why we behave as we do. It is all too easy to say someone is stealing because they are a bad person, or because they had a difficult upbringing, but these phrases do not really mean very much in themselves. They are throwaway descriptions used inappropriately to describe why people act as they do. ‘Thick descriptions’ are the much more detailed accounts we use to provide a more detailed explanation of something, the type of description used in narrative therapy. We rarely delve deeply into our lives if we are left alone. We only usually dig deeper if someone (a friend, a therapist) starts asking questions, or if we are experiencing a significant life event.

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People experience their lives through stories, but usually these are thin stories. We usually have no need to dig deeper into the ways we think about our lives, we just get on with things. Geertz (1973) discussed ‘thick descriptions’, rich meaningful multistranded stories of lives. When therapists meet clients, they also generally use thin stories that focus on just some of their experiences and have limited detail. It is the therapist’s job to look for things that are missing, events that are not predicted by the plot of whatever the problematic story might be, listen for literal exceptions or counterexamples to the problem. Then ask questions about the event that is outside the problematic storyline. Over the course of therapy, people tell more and more detailed life stories, they develop multiple storylines that speak of multiple possibilities for lives. It is out of these that the solutions to the problems are found. White (2000) discussed the ‘rich story development’ role of narrative therapy, that is, developing thick descriptions. People do not invent problems; they are recruited into actions and ways of thinking that create problems. Narrative therapy helps bring these to light, and let people see gaps in their problem stories. This can only be done by ensuring that the person tells a rich and detailed story. Double Listening The meaning we make of an experience comes from contrasting it with some other experience. There is a need for double listening, listening for ground as well as figure. Then we can hear experiences being drawn on as background for the present experience; these implied or implicit experiences are a rich source of preferred stories. For instance, if a person experiences frustration (figure), they may be pursuing dreams or goals and not attaining them (ground). The therapist can then ask about these goals. White (2006) introduced the term, to describe how people talk about trauma and its aftermath. The story about the person’s response to trauma may be hidden in the shadows of the more dominant trauma story. White says that it is important to actively support people talking about trauma, while listening for the ways they have responded to the trauma as well as to what they value. The stories of how they responded are often dismissed or diminished, which can lead to personal desolation or shame. Developing their stories of trauma can be a powerful counter story to the idea of being a trauma victim. Acknowledging this counter story can help the person develop a preferred sense of self.

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In the dynamic struggle between voices, a dialogical disruption can occur when the diversity of voices regarding a problem collapses into the monologue of a single voice; the other voices are silenced, making different constructions of events difficult. This is normal. We generally have a single fairly simple story about the world, and this usually works, so we stick to it. The narrowing of perspective, of story, may become more extreme when there are mental health problems. This is similar to White’s ideas about problem-saturated stories, where all accounts other than the problem one are undermined or silenced. This never totally happens. As Bakhtin (2000) argues, attempt to suppress the other (external or internalised story) is never totally accomplished given the dialogical nature of existence. There are always alternatives ways of expression. White and Epson (1990) recognise that life is more than what is narrated, so there are episodes outside of the problem-saturated story – exceptions we call ‘unique outcomes’. Focus on Unique Outcomes This is an older idea which comes from Irving Goffman (1961) but is crucial to narrative therapy. Each person is unique, there are no one-size solutions that fit everyone. Our stories are all different, which is why it is important to get all the relevant details before trying to make any changes. In the narrative metaphor of psychotherapy, clients transform themselves by changing their life stories. For White and Epston (1990), the construction of change occurs from the expansion of unique outcomes, the development of episodes outside the problem-saturated narrative. Some unique outcomes provide temporary release from the problem but also facilitate a return to it. One type of unique outcome, reconceptualization, facilitates sustained change (Goncalves et al., 2009). This facilitates the emergence of a meta-level perspective about the change process itself and in turn enables the active positioning of the person as an author of the new narrative. In this way, the person is not just changing their individual narrative but they are understanding the process of change more fully, which could potentially have significant longer-term gains. The therapist maintaining a stance of curiosity and always asking questions they genuinely don’t know the answer to.

Morgan’s (2000) two main principles of narrative therapy are: maintaining a stance of curiosity and always asking questions that you genuinely do

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not know the answers to (these are principles that therapists of all perspectives will use). The therapist needs to remain curious and ask questions with unknown answers because they are helping the person to understand their own stories, particularly elements of the stories that they may be finding difficult. It is not the role of the therapist to provide the story, but to help the person find their own story. Curiosity and questioning are critical to this. White (2000) suggests it is helpful to take a ‘not knowing’ stance. This means not assuming or pre-judging what a person needs to achieve. If the person gives directions in the discussion, they can lead the therapist down the route that is most helpful. A therapist might ask about the person’s hopes, and the person may not initially be able to answer this question, but through the process of therapy, it will hopefully become clear. Clients as Experts The assumption is made that clients know what is good for them. This may be a questionable assumption, but it is important in narrative therapy. It is only the client who knows their own life intimately and has the skills and knowledge to address the issues and change their behaviour (Morgan, 2000). It is up to the client to decide that their current life story could be improved upon, and it is up to the client to decide whether a particular new story is better. An obvious problem with this is that many people have difficulty understanding their lives to a sufficient extent to make active and sensible (to them) changes. This limits the people who will benefit from narrative therapy, but it does not undermine it as a therapy. Culture and Social Environment As we have seen, narratives are usually developed in specific social and cultural conditions, and to some extent, depend on these conditions. Effective narrative therapy must take these conditions into account, whether they are about the people the client knows, the place they live, where they work, their education, training and so on. Without this wider context, any narrative development has little meaning as the narrative has to make sense within the environment. According to Bruner’s (1986) narrative metaphor, people’s identities are defined and constructed through stories, some of which are common across individuals and groups. There is power involved in deciding which stories will be told and retold and which will not. The sharing

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and circulation of different stories contribute to building communities. Stories give meaning to lives, privileging some people and relationships and making others invisible. According to Combs and Freedman (2012), narrative therapy is useful for therapists who wish to work for social justice, because by changing individual narratives, there is the scope to change social narratives, the general ways we think about the world. Identity is relational, distributed, performed and fluid. Who we are and can be cannot be determined outside our relationships with others and how we think they perceive us. The social world is very important when it comes to the resolution of problems. Redescription Redescription is a powerful tool that is fundamental to narrative therapy. Instead of describing themselves in the problematic ways they did before therapy, clients begin to describe themselves differently, representing themselves in a different way to the world, creating a new presentation of the self, a new life story. It is about helping the client to recognise their preferred qualities in themselves and to probe any implications for their identity. Solution-Focused Narrative Therapy (SFNT) One of the problems faced in narrative therapy (indeed in many aspects of life) is that some therapists may feel a need to jump in and offer aid too quickly. This is well-intentioned but may lead to problems because the therapist’s assumptions may be wrong, partly because they are based on too little information. This may lead to a restriction of opportunities within the therapeutic situation before the person has had the opportunity to consider the wider picture. It is often a similar problem in coaching. Buddha noted that ‘what we think we become’, so it is important not to make judgements too early. In solution-focused therapy, clients reflect on the times they had successfully devised solutions to problems, or times when the problem occurs less often. Rather than talk about the problem, the therapist guides the client toward seeking out a preferred future. Solution-focused narrative therapy (SFNT) can be summarised as ‘listen, select and build’ (Metcalfe, 2017). SFNT encourages clients to look at their presentation of the character that appears in the stories that brought them to therapy. Through a blend of solution-focused and narrative

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questions, the therapist seeks new presentations that will lead to new results for the client – without knowing anything about the problem that brought them to therapy. Metcalfe (2017) presented the following guiding constructs of SFNT: – Invite clients to see events in life as chapters – Assist and encourage clients to see out successful events – Integrate complains as situations that interfere in a client’s preferred life, rather than diagnosing the client – Write down all key words the client uses in a session and use those words when talking to them – Follow wherever the client wants to go in therapy, refrain from assuming they are avoiding the key issues – Capitalise on successes in clients’ work, hobby, profession that can lead to solutions elsewhere – Convince clients that the problem-saturated map they focus on is full of tributaries of success – Promote hope by suggesting the client forgot to be competent, assertive or responsible during problem-saturated times – Avoid revisiting traumatic events as may be retraumatising – Instead of praising, be enamoured of clients’ successes – ‘how did you do that?’ – Hear every goal the client provides you with as one that will make a positive difference – See your role as keeping track of exceptions, meaning and values throughout the session. Write them down and give them to client at end of session – Write to clients in their language about success – Use scaling questionnaire to measure where they are in reference to their preferred future – If they say what they don’t want, ask what they do want – If they talk about the past, ask how it is helpful – Ask how relationships might change as they change – Go slowly The Odyssey and Narrative Therapy Literature – novels, plays and so on – is underused in psychology generally, and this is the case in narrative psychology. Christensen (2018) suggests that we, both therapists and clients, can look at Homer’s Odyssey

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from the perspective of narrative therapy, particularly regarding agency and responsibility as recognised by Homer. Christensen suggests that Odysseus’s retelling of his own tales reflects an understanding of the function of narrative and a need to tell a particular type of story before he can journey home – that Odysseus undergoes a therapeutic process, changing his own narratives to negotiate the relationship between the gods and his own responsibility, and challenging readers to reconsider their own stories and their own lives. There is a recognition of the power of traumatic memories and how retelling them can be beneficial, in narrative therapy terms, re-authoring conversations. This ensures that Odysseus can redefine his sense of self, gains agency and can plan for the future. Christensen’s argument is that the Odyssey represents narrative therapy and that those interested in narrative therapy (either as therapists or clients) may benefit from a reading of the book. Christensen (2018) argues that the key element in the Odyssey is the Apologoi. Before this, Odysseus has little agency and is incapable of acting. The Apologoi, in the middle of the book, is a transition point, and that following this retelling of his tales, Odysseus becomes powerful, with intentional control over his life. Specifically, Odysseus is isolated without agency on the island of Ogygia. Later, he is shipwrecked where he discovers he has some control over his fate. This is the first step to gaining control, in reclaiming self and agency. He then tells his stories, identifying the mistakes that led to his suffering. Instead of this all being the fault of the gods, Odysseus recognises his own agency, thus demonstrating the importance of how a changed narrative can enable a person to take control over their life. According to Christensen (2018), examining the Odyssey enables a third strand of narrative therapy to be added to re-authoring and externalising; remembering conversations. These allow the person to revise their constructions of identity with respect to identities of the past, present and future. This acknowledges the importance of identities not being independent of others, but a part of those around us, and the culture we live in. Evidence for Narrative Therapy The information in the chapter so far is all very well, but where is the science behind narrative therapy? The theoretical positions adopted by narrative therapists and theorists is complex and to a large extent coherent, but the question remains as to whether it works. When people undergo narrative therapy, do they feel better at the end of it? Do they understand

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themselves better? Have they dealt with the problem and changed their narratives? We need to know not only whether they are in some way better but whether it is narrative therapy that has had the effect. To determine whether this is the case, we need to compare narrative therapies with appropriate controls, including other forms of therapy. The well-known Hawthorne Effect suggests that people will report positive effects simply because someone has attended to them, has listened to them and it may have nothing to do with either therapy or the therapeutic approach. This is where it becomes difficult to support narrative therapy. While the approach is intuitively positive, based on the relatively simple idea that a person with a problem just needs to change their story about life, we do need the evidence that it works. While the theory is relatively strong, the evidence for narrative therapy is relatively weak. The evidence for the effectiveness of narrative therapy, at least evidence in the traditional sense, is somewhat limited, but there are an increasing number of studies which do suggest it works. There are a few randomised controlled trials (RCTs). The problem for narrative therapy is that in order to be accepted by the general therapeutic community, such evidence is important, and we need to encourage such trials. Some studies examining narrative therapy does not achieve the required level of evidence. For instance, Cashin et al. (2012) conducted a study to see whether narrative therapy is effective in helping young people with autism who are presenting with emotional and behavioural problems. They do note this is a pilot intervention, but there is only one group. Ten young people aged 10–16 with autism had five 1-hour sessions of narrative therapy, using a variety of measures. The study found significant improvement in psychological distress and in emotional symptoms; but without a comparison group, we cannot say whether it is narrative therapy having the impact or some other factor such as the Hawthorne Effect, or just time. There is a lot of similar evidence, much of which seems to show narrative therapy having an effect, but with no control. Vromans and Schweitzer (2011) provided narrative therapy to forty-seven patients with depression and found improvements. Again, no control group for comparison. McKian et al. (2019) conducted an experimental study to assess narrative therapy with overweight women. Ten women in a diet therapy group received a weight loss diet for 5 weeks, another ten women received weight loss diet and narrative therapy (ten sessions, twice a week, each lasting 50 minutes). Finally, there was a control group. The results showed that diet therapy with narrative therapy had significant effects on body image and significantly decreased body mass index (BMI), but this was not clinically

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significant. McKian et al. concluded that this is a useful intervention for improving body image, with a focus on positive experiences. The problem is that it is not really a test of narrative therapy. It is not comparing narrative therapy to another talking therapy, something that is equivalent. It is providing diet information along with talk. As we know, people will change or improve their behaviour because someone pays attention to them. This study is not evidence that narrative therapy works. It is evidence that paying attention to people works. Sun et al. (2022) conducted an RCT to see whether narrative therapy may help to relieve stigma in oral cancer patients. One hundred patients with oral cancer were randomly allocated to either standard care (control) or standard care plus narrative therapy. The level of stigma was assessed before and after treatment and it was found that narrative therapy effectively relieved patients’ sense of shame, it reduced overall stigma and improved self-esteem and relationships. This is a good sign, but it has the problem of the McKian study in that participants were getting standard treatment or standard treatment plus narrative therapy, which means that it may again be an effect of therapists paying attention to patients rather than active elements of narrative therapy. This is a difficult situation. We need to conduct RCTs to test narrative therapy, but if we are going to show that narrative therapy is having a specific effect on people’s health and well-being, then we need to do this by making comparisons with other similar, equivalent, treatments. It is not enough to compare treatment with absence of treatment because this does not tell us that it is the treatment itself that is having the effect unless a waitlist design is used. It would be better to either compare narrative therapy with another form of talking therapy and see whether it works better or to employ a waitlist control, so that people effectively act as their own controls. I do find it frustrating because I do want to see that narrative therapy works, as intuitively it should – but while intuition is helpful in science, it is not enough. Lopez et al. (2014) conducted an interesting study comparing the effectiveness of narrative therapy and cognitive-behavioural therapy for treating depression. The attrition rates for both conditions were similar, and both groups showed a similar success rate, with CBT slightly better. Scores on the Beck Depression Inventory (BDI) were similar at 31-month follow-up. While the authors did not discuss the effectiveness of narrative therapy in detail, the evidence shows that it has a similar effectiveness to CBT. One recent study employed a waitlist control to explore the effectiveness of narrative therapy in vulnerable African children, orphans and

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abandoned children with attention deficit and hyperactivity disorder (ADHD) and anxiety disorders (Karibwende et al., 2023). Half the participants (n = 36) were allocated to the narrative therapy group and half to the waitlist control group. The results indicated that narrative therapy improved both anxiety and ADHD. While the longer-term effects were not examined, this does show that narrative therapy can be effective. Difficulties Part of the problem is the relative newness of narrative therapy and its lack of widespread acceptance. It is a difficult situation for a new therapy to become mainstream as therapists will, quite rightly, ask for evidence that it works before they train to use it, but in order to see whether it works, we need therapists to use it! A further problem is that the efficacy of narrative therapy may be difficult to demonstrate using traditional methods, in part because the problems dealt with by narrative therapists may not conform to traditional ideas of disorders of mental health, and so may not be measurable in the same way. This may mean that alternative ways of validating narrative therapy may be necessary, particularly qualitative methods. The problem here is that asking someone whether a therapy they have used (and usually paid for) is effective is hardly objective, and many will state that it has helped because they do not want to think they have wasted their time and money. A controversial problem with narrative therapy is that it has some of the characteristics of a cult (as do many forms of therapy, but that is for a discussion elsewhere. It is perhaps in the nature of therapy to acquire cult status). Many people have been trained in the techniques of White and Epston and claim great successes in their treatment, but as we have seen the evidence base for narrative therapy is weak. This does not mean that narrative therapy does not work, but it is difficult to establish good evidence using traditional techniques such as RCTs. The key problem is that any benefits of narrative therapy may not be recognised through traditional methodological approaches. The benefits of narrative may be difficult to measure using traditional instruments. Many narrative therapists reject DSM and ICD, arguing that we should not medicalise mental health problems. If we cannot classify a disorder, how can we know whether that disorder has been ‘cured’? These are problems with narrative therapy that need to be highlighted and resolved. It does not mean that narrative therapy and the techniques used in narrative therapy are not valuable, just that

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they should be considered with caution, though they may be useful techniques to use in psychological therapy, counselling and coaching. Narrative therapy assumes that people are experts, that they are effective at knowing and constructing narratives, that they are open thinkers who will change their ways of thinking as the situation dictates, that they can change their life stories even though they may have been thinking the same ways for many years. This may be the case for some people, but many people are unable to think in this way, whether because they have never been trained, they have never tried it or they are intellectually or emotionally incapable of such thought. For instance, if we ask a person about their hopes for the future, a person may answer that they do not have any. Some people will eventually come round to realising that they do have hopes, but others will not. It is difficult or impossible to use narrative therapy with the latter group. Another problem for narrative therapy is that there are many people who do not wish to talk about their problems, who believe – rightly or wrongly – that they will not benefit from such methods. This is an issue associated with all forms of talking therapy, but it has not been properly researched. We simply do not know who is suitable and not suitable for receiving therapy, narrative or otherwise. Conclusion Narrative therapy is appealing. When you read about it, there is a sense of meaning, a sense that it must work, because the fundamental meaning of life is expressed through stories and if these stories can be constructed or reconstructed in positive ways, then this must have a positive effect on the client. The problem is, as we have seen, that the evidence for narrative therapy is, let’s face it, weak. It has been written about extensively, and a few studies have been conducted that seem to show that narrative therapy works, but there is not enough good scientific evidence that it works. That does not mean that narrative therapy does not work, but it does mean we need to be careful in its use and we need to conduct the studies to show whether it works or not. There are problems with the evidence for most kinds of psychological therapy, partly because the key technique used, the RCT, is designed to be used in medicine where it is relatively straightforward to introduce experimental and control groups and keep all participants blind to which arm of the study they are in. This is very difficult in psychology. If you are receiving therapy, then you usually know you are receiving therapy. If you are receiving therapy, then you want it

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to work, so you are more likely to report that it does work. Furthermore, there are often problems with people dropping out of treatment because they find it too difficult, they don’t enjoy it, they think it is not working, it is too difficult and a host of other reasons. These dropouts are not always recorded in therapeutic trials, which means that only enthusiastic patients may succeed in completing the trial and so the therapy will appear successful, which it is, but only for a subset of those who have problems. Another difficulty with assessing the value of psychological therapy is that only a certain subset of the population will be suited to such techniques, and they only work with certain mental health problems. Talking therapy is useful to some, but also useless to others. I have no idea what proportion of the population affected by mental health issues will benefit from psychotherapy, but it is a subset, not everyone. This is not the place to go into these issues in great detail, only to highlight the dangers of interpreting psychological evidence relating to psychotherapy, and to indicate that just because there is limited good evidence for the utility of narrative therapy, that does not mean it does not have its uses. I argue that (a) psychotherapists can draw on the techniques of narrative therapy as part of an eclectic approach and (b) that we should be designing good studies to test the usefulness of narrative therapy as a technique in its own right. To do that, we need controlled studies (even though there are problems with the method). Another important concern is that narrative therapy is seen as a constructionist approach where there are no absolute truths, which might lead to a conflict between a person’s post-therapy narratives and the dominant cultural master narratives. This suggests a fragility of narratives whereby post-therapeutic experiences may undo any positive benefits. The use of a constructivist approach limits the extent of narrative therapy. The notion that the self is a changeable and changing construct, dependent on people’s experiences, outlook, relationships and so on, is fundamentally flawed. Ask anyone and they will indicate that there is a commonality throughout their lives, a sense of selfhood that does not change. While we acknowledge our identities develop and change – both for the worse and for better – we have to also acknowledge that there are key elements of our selfhood that remains the same, and that is perceived to remain the same, throughout life. Narrative therapy, if it is to be successful, needs to show how it can impact on the stable elements of our personalities. There may need to be a theoretical development that explicitly recognises that there is a fixed self and elements of person characteristics that are also fairly fixed.

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While narrative therapy instructs that ‘the person is not the problem, the problem is the problem’ and that arguing, for instance, that someone who regularly acts in an aggressive manner and calls themselves an ‘aggressive person’ is providing a thin explanation, the answer is not necessarily that a thick explanation will remove that construct and replace it with an explanation around how and why someone behaves in an aggressive manner in certain situations and not others. The reality is that aggressiveness can be part of a person’s character, part of their biological and psychological make-up, and will not be changed. The job of the therapist here is to help the person control the way they behave to others, so that they display aggression less frequently. Whether narrative therapy has a role here remains to be seen. Like all therapies, it is likely that narrative therapy may be effective for some kinds of problem and not for others. The causal explanations provided by narrative are usually incomplete and biased. Critical to understanding the narrative approach to psychotherapy is that it allows new stories to be constructed from a given state of affairs, stories which may be more empowering and useful to the patient, increasing their options for the future and their sense of agency. If we can establish that narrative therapy can actually do this, and that it does make a difference, then it could be a powerful therapy.

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Chapter 9

Narrative Exposure Therapy

The problem in many areas of the world, especially war-torn countries and countries seriously affected by natural disasters, is that they are often relatively poor and tend to have few psychological practitioners to deal with the often significant problems relating to traumatic stress. While the first requirements of anyone affected by war or disaster are safety, shelter, food and water, it is also important to deal with psychological problems in a timely and practical manner. While it is not always possible or desirable to bring in psychological practitioners or counsellors, it is possible for people to help themselves. Throughout this book, I have emphasised the centrality of narrative to human existence. It is something we all do every day, so if we can develop a therapy for traumatised people based around narrative, then it could be highly effective. This is precisely what narrative exposure therapy (NET) has been devised for. It is a form of narrative therapy that can be administered not only by highly trained practitioners, but also by people who have received fairly basic training as it is a fully manualised and practical form of therapy. As it is based on narrative, it is already familiar to those practising it and those being treated with it. The other advantage NET has over narrative therapy as described in the last chapter is that there is a very good evidence base that it works as a treatment for post-traumatic stress disorder (PTSD). Indeed, it has been accepted as a valid form of treatment under the The National Institute for Health and Care Excellence (NICE) guidelines in the UK and also in the USA and elsewhere. NET (Neuner et al., 2004a, 2004b) was developed as a short-term psychological therapy for people with PTSD (APA 2013). It was originally proposed to find a suitable method for treating refugees in camps that may be difficult to access for mental health professionals and was manualised in order to provide a means of training people in the use of the technique where there are limited resources available (see Schauer et al., 2011, for full details). 121

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NET is a well-evidenced approach to dealing with psychological trauma. It is based on the principles of cognitive behaviour therapy (CBT) and testimony therapy (Cienfuegos & Monelli, 1983). Over the years, it has become widely used across a range of trauma-related situations across the world, not only in refugee camps and in disaster and war-torn areas. NET can be delivered by non-mental health professions following a short training programme, using the oral tradition of storymaking and storytelling, which is intrinsic to the human experience (Onyut et al., 2004). Traumatised people often have difficulty making sense of their experiences, understanding what has happened and placing the experiences and their behavioural, cognitive and emotional responses in the context of their personal autobiographies. NET’s manualised procedure is designed to help people develop a consistent and coherent narrative of these experiences, whether they result from war experiences (either as a soldier or civilian), rape and sexual abuse, disaster or other life-threatening events. The paradigm is based on cognitive behavioural models relating to PTSD (e.g. Ehlers & Clarke, 2000), which describes a key set of symptoms, including intrusive thoughts, avoidance of reminders about the traumatic event, negative alterations in mood associated with the events and marked alterations in levels of arousal and reactivity. People with PTSD experience a current sense of threat or danger. The model contains information about a number of domains including memory, appraisal and behaviour. The person with PTSD has problems with memory relating to involuntary recall, fragmentation, high levels of vividness, emotional and sensory re-experiencing, with a sense that the events are recurring now rather than at some point in the past. The appraisals people make relate to creating a sense of current threat and appraisals relating to the world (‘the world is a dangerous place’), other people (‘other people are a threat to me’) and the self (‘I am incapable of sorting out this problem’). The resultant behaviours are dysfunctional, and may include avoidance, for instance, avoiding people or places that remind them of the event, or emotional numbness, with the inability to experience not only negative emotion but also positive ones such as love or happiness. These strategies can prevent positive change and lead to chronic PTSD. This is where NET comes in, as a means of helping the person to change the ways they think, feel and behave, drawing on narrative. The NET manual (Schauer et al., 2011) provides detailed information about PTSD and the process of administration. NET usually consists of eight to twelve sessions (though it can be reduced to four and sometimes two sessions if necessary and possible, e.g. Zang et al., 2013), which involves a number of processes. This starts with diagnosis and psychoeducation.

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It is important that the person realises that their traumatic symptoms are normal for people who go through similar events. In the next session, the Lifeline is laid out, which provides an overview of the key moments, positive and negative, in a person’s life. After this, the narration proper starts. While the whole of the person’s life is addressed, the focus is on the traumatic incidents where very detailed accounts are obtained. The focus is on ‘hot’ memories, traumatic memories that trouble the person, memories that the person finds difficult to manage because they are so traumatic. While most normal memories are dealt with quickly, these hot memories are dealt with in a lot of detail. Each session focuses on a single traumatic incident, and it is important that the whole of the memory is dealt with in a single session. Subsequent sessions focus on other traumatic memories. During a session, the person is likely to experience high levels of arousal. Sessions should only end when this level of arousal is significantly reduced. An important aspect of creating the narrative is writing down the story for each session. The therapist takes a record of the narrative account, and at the beginning of the subsequent session, the story is read out to the person to ensure its accuracy and to fill in any details. In some cases, this will mean the person again experiences high levels of arousal, but this helps with habituation, coming to terms with the memory. In the final session, the whole written report is read to the person and final corrections are made. By this time, the narrative should have lost its arousing impact. Hopefully the person will have a sense of distance from the traumatic memories. This report is signed off by the person as an accurate account of their experiences. This could be used as testimony against any perpetrator of the traumatic events. See Table 9.1 for a summary of the NET process. The therapeutic elements that have proven effective using NET include the active chronological reconstruction of the autobiographical memory, exposure to ‘hot spots’ through detailed narration and imagination of traumatic events through high levels of emotional involvement, cognitive re-evaluation of behaviour and patterns and re-interpretation of meaning associated with negative, fearful and traumatic events, revisiting positive life experiences to activate resources and to adjust basic assumptions and – importantly – regaining dignity. It is in telling the story in detail that the person regains a more coherent and positive sense of self. It is the nature of storymaking and storytelling that in itself is beneficial. The role of the therapist is to be an active questioning audience to facilitate the person’s reconstruction of their autobiography.

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Session 1 Session 2

Informed consent Psychoeducation

Session 3

Lifeline

Session 4, etc. Narrative exposure

Penultimate session Closing session

Future Testimony

Establish voluntary consent, build rapport, gain trust Normalisation (normal to have such reactions after trauma) Legitimisation (the symptoms are a result of responses to the traumatic situation Description of trauma reactions Explanation of therapeutic procedure (imaginative exposure and habituation, step-by-step explanation of process Physically construct the life story to highlight highly arousing, positive and negative/traumatic events across the life in a chronological manner Focus on context, detail, emotional engagement, context, chronology, description of sensory, emotional and physiological and behavioural experiences Structure and record testimony between sessions Exposure through re-reading narrative from previous session for corrections, further detail and reprocessing Repeat procedure until final version is reached Positive discussion regarding hopes and aspirations for the future Re-reading and signing the complete testimony after correcting inaccuracies and making changes

Evidence Base for NET Unlike the evidence based for narrative therapy, NET has been evaluated through randomised controlled trials (RCTs) in a range of populations in a variety of settings. A systematic review by Robjant and Fazel (2010) examined studies conducted with several traumatised groups in different cross-cultural and income contexts, including Sudanese refugees in Uganda (Neuner et al., 2004a) to asylum seekers and refugees in Germany and Norway (Halverson & Stenmark, 2010). NET improved symptoms more effectively than psychoeducation, trauma counselling, supportive counselling and group interpersonal therapy. There were also positive effects over the longer term. Gwozdziewycz and MehiMadrona (2013) examined seven trials, showing NET was more effective than treatment-as-usual, interpersonal therapy and other techniques. More recently, two meta-analyses, one by Lely et al. (2019) and one by our team (Raghuraman et al., 2020), taking into account the risk of bias estimates and quality appraisal of the included

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studies, have highlighted limitations of NET including low study quality and high heterogeneity between trials. These limitations arise at least in part because of the difficulty of validating a procedure mainly used in difficult circumstances such as refugee camps. They also highlight the difficulty of RCTs generally as a means of validating psychological procedures which are inherently highly variable between those receiving the treatment. Nevertheless, NET fulfils the criteria for treating PTSD and has been recognised as such in the UK by NICE (2018) and in the USA by the American Psychological Association (2017). There is evidence that NET provides more effective treatment for PTSD than for a number of other treatments, including stress inoculation training (Hensel-Dittman et al., 2011), treatment-as-usual (Stenmark et al., 2013), emotional freedom technique (Al-Hadethe et al., 2015) and waitlist controls (Alghamdi et al., 2015; Hijazi et al., 2014; Jacob et al., 2014). There is some evidence that NET has lower dropout rates (Morkved et al., 2014), which is not surprising as the process is one of storytelling, a natural human process, rather than the more obscure techniques used in many treatments. Morkved et al. (2014) also found that fewer sessions were needed for NET, something we found when treating Chinese earthquake survivors, who benefitted from four, or sometimes even two sessions (Zang et al., 2013, 2014). This is important in situations where there are limited resources, and will be further discussed in Chapter 10. One of the main advantages of NET is that it can be and has been used in a variety of contexts across the world, including Rwanda, Somalian Uganda, Iraq, Iran, Saudi Arabia, China, Romania and the UK. There is an adaptation for forensic offenders (FORNET; Hermenau, et al., 2013; Hinsberger et al., 2019; Kobach et al., 2017), and it has been used not only with adults but also has been adapted for children (KIDNET; Catani et al., 2009; Onyut et al., 2005). Though storytelling is a universal human trait, there are limitations to the NET procedure, which is based on Western conceptions of PTSD and the response to traumatic events. Mundt et al. (2014) noted the lack of connectedness of NET trials to the local psychosocial care systems and questioned whether it was effective as a standalone intervention in settings where the political context, collective healing mechanisms, family and social dynamics and community functioning were not properly considered by the studies. In many cultural situations, psychosocial problems are dealt with through social connections and are considered a part of social life, rather than in the disconnected way treatments are dealt with in the West.

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In our research, we have identified problems with NET. We conducted a study with Saudi firefighters and found that NET did reduce symptoms (Alghamdi et al., 2015) but the procedure did not provide the skills necessary to deal with future traumatic events. After a series of serious fires, post-treatment symptoms among the firefighters increased. In discussion, the firefighters would have liked the NET procedure to be used as a ‘top up’ on a regular basis to deal with continuing events. This idea may suit emergency and military groups but so far has not been tested. We also used NET in Iraq (Al-Hadethe et al., 2015) and found limited effectiveness in dealing with the problems of continuing violence. The NET treatment was conducted in Baghdad while high levels of violence continued, with car bombings, shootings and kidnappings. While there was some limited short-term effectiveness, symptoms of PTSD did not significantly reduce over time. Both these studies tentatively indicate that while NET is effective at reducing symptoms of PTSD, it does not provide support for the individual to deal with future traumatic experiences. It does not provide the skills necessary for such support. While there is no evidence around this, it is likely to be because NET is using a storytelling procedure which is to deal with past stories. The narrative skills an individual has are not enhanced by NET. It is the story itself that is enabling improvement in traumatised people. For future traumatic events, though the person has the storytelling abilities, they still need to construct the story to deal with the symptoms. The idea of a ‘top up’ NET for certain groups has a strong appeal and should be tested.

Testimony This testimony element is important as telling stories is a natural process, and in a way testimony as a therapeutic intervention has probably been an informal way of helping people deal with difficult circumstances for thousands of years. Many people who go through NET see it as a means of telling their story or making it public rather than just as therapy. Testimony therapy was described by Cienfuegos and Monelli (1983). During Pinochet’s dictatorship, they collected the stories of former political prisoners of the regime. They were attempting to document the repression, but they also found that enabling these people to tell their stories had therapeutic value. The purpose of testimony therapy is to enable people to tell their stories, particularly the traumatic elements. The stories are recorded and transcribed. They are then signed off and people can do what

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they wish with them, keep them private, give them to family and friends or send them to courts or human rights organisations, potentially as testimony for court action. Testimony therapy has been used with various groups such as refugees (Agger & Jensen, 1990; Weine et al., 1998) and Holocaust survivors (Laub, 1995). Dignity, the Danish Institute against Torture, published a manual for testimony therapy (Dignity, 2014), suggesting that testimony therapy has a number of healing elements, including regaining dignity and self-esteem, integrating a fragmented story, re-experiencing fear in a safe environment leading to diminished anxiety, understanding how present events can generate thoughts and emotions relating to the traumatic event and adding a mindfulness element to further reduce stress and anxiety. Dignity proposes a four-session testimony process which opens with mindfulness and psychoeducation, and then a monitoring and evaluation questionnaire is completed, before moving on to the person providing details of the story with questions from the therapist, the story is written up and in the next session, read aloud to the survivor (giving voice to the story), the person discusses their feelings, and again mindfulness is used. Afterwards the therapist corrects the story to provide a final version. In the third session, the final version of the story is read aloud to the survivor, signed and then presented to the survivor, preferably on good paper, bound, and with a photograph of the person on the front page. This could be a public event with several survivor stories. The final session takes place a month or two later and the monitoring and evaluation questionnaire is again completed to make a comparison with scores at the outset. The results are analysed and discussed. Van Dijk et al. (2003) described how they used testimony therapy with Chilean former political prisoners, and how the procedure helped reduce post-traumatic symptoms. With testimony therapy, the person describes their story over twelve sessions. The narrative is then transcribed into a written document that can be given to family and friends or added to a historical archive. More recently, studies have continued to demonstrate some benefit to testimony therapy (Agger et al., 2009, 2012; Curling 2005; Jørgensen et al., 2015). There are few studies using RCTs to examine testimony. One exception is Esala and Taing (2017) who conducted an RCT to test the effectiveness of testimony therapy among Khmer Rouge survivors from Cambodia. They found that significant benefit was obtained when testimony therapy was combined with a culturally adapted ceremony rather than with testimony therapy itself, suggesting the importance of social ritual, of sharing

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the story with others. The ceremony included a Buddhist ceremony and a truth-telling event. What is difficult to tease apart in this study is whether the benefit was gained through testimony therapy or the ceremony. The evidence so far for testimony therapy does suggest that it has some benefits for people who have been traumatised. A difficulty is that there is no set format for the testimony, and the stories told can have different formats. An important element, as noted elsewhere in the book (e.g. narrative therapy and narrative life interview), is that the person needs to talk about feelings and thoughts regarding the traumatising event. Without that element, the benefits may be limited. It is the usual story in psychology, the difficulty of comparing different methods, different approaches, to similar questions. This is why NET is easier to examine, because it has a set format, though there is still a problem with RCTs – as there is across psychology.

A More Detailed Examination of the Evidence for NET As already noted, it is difficult to conduct full RCTs to examine the efficacy of NET. It is difficult to do so with any psychological treatment for any psychological disorder as it is functionally impossible to control all the variables necessary to conduct a trial with the same level of validity as, for example, when testing a drug. Any psychological treatment will involve variation in the treatment as people are involved. The treatment of one person for depression using any form of talking therapy will never be the same as for another person. Individual clinicians always take different approaches and make different decisions regarding their patients. Patients are always different. They have different backgrounds, problems and needs. For these reasons, we can only ever use RCTs as one tool among many in determining whether our treatments are effective. Also, there are problems with the classifications of the ‘disorders’ that are treated by psychologists. PTSD, depression and anxiety are all contentious classifications as already discussed. This is not medicine. Having said that, RCTs are still one of the better tools we have for determining whether a psychological treatment is helpful, and as we have seen, NET does appear to be helpful. The evidence is fairly consistent on this. It is worth pointing out though, that the evidence has a number of serious limitations, as we discovered when conducting our systematic review (Raghuraman et al., 2020). NET is an unusual technique because it is meant to be used by people without full psychotherapeutic qualifications in places where it can be

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difficult to find psychologists with people who have been through terrible experiences and who live in difficult circumstances, often having lost loved ones and homes. NET begins from a difficult position, and for it still to work given these conditions demonstrates the power of narratives, and the power of constructing systematic narratives focusing on people’s most difficult memories. The review, published in 2019, demonstrated the efficacy of NET across a range of situations and populations, but also highlighted some of the problems. Some of these problems result from the application of NET and the procedure itself, but others relate more to the problems of using RCTs with this kind of treatment. Overall, the review demonstrated that NET works with a variety of populations in a variety of situations. Using strict systematic review criteria, our review included twenty-four studies with a total of 1,391 participants. The populations were varied, including refugees and asylum seekers, firefighters, former street children and former child soldiers, veterans, exprisoners, survivors of partner and sex abuse, orphans of genocide and earthquake, Iraq, Romania and Burundi survivors. They came from around the world, including China, Germany, Saudi Arabia, Norway, Uganda, Congo, USA, South Africa and Rwanda. The effectiveness of NET here indicates the universality of narrative. It is not culture-dependent, narrative is used by everyone. The outcome measures usually included PTSD, but also depression and anxiety, and other negative symptoms. Participants ranged in age from seventeen to seventy (children were excluded). The trials used either NET in its original form, FORNET, a forensic offender rehabilitation form of NET or a brief form of NET. The studies were controlled in several ways such as waitlist control, treatment-as-usual, psychoeducation, emotional freedom technique, stress inoculation training and various other forms of therapy, some of which have limited evidence of utility. Most of the trials measured severity of PTSD as one of the primary outcomes. Measures of PTSD included the Clinician-Administered PTSD Scale (CAPS; APA, 1994), PTSD Symptom Scale (PSS-I; Foa et al., 1993; Foa & Tolin, 2000), the Composite International Diagnostic Interview (CIDI; WHO, 1990), Post-traumatic Stress Diagnostic Scale (PDS, Foa et al., 1997), Scale of Posttaumatic Stress Symptoms (SPTSS), the Impact of Events Scale – Revised (IES-R; Weiss & Marmar, 1997), among others. This introduces a further problem, regarding the status of PTSD and how it is measured. As previously discussed, the diagnostic criteria for PTSD

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are contentious. Many people working in the narrative area would not accept the validity of the diagnosis, nor of the means of assessment. Be that as it may, in pragmatic terms, the studies assessed a construct we call PTSD and found that in most cases, NET had a positive effect on it. What the findings indicate is the difficulty of conducting studies using a manualised procedure with therapists of limited training and clients with severe and variable difficulties in situations that are often dangerous or difficult for other reasons. Given all these potential problems, and the still consistent finding that NET works is an indicator of the power of both the NET procedure and the narrative approach generally. Unusually for psychological therapies, there was a very low attrition rate, with a mean of 7.43 percent during treatment, which is lower than most treatments. This is likely to be because NET is using the natural process of narrative rather than asking people to do extraordinary abnormal things during treatment. Just telling a story does not introduce unnecessary stress or effort into the process, and most people like to tell their stories (if they are too difficult to tell, they are not going to undergo any form of psychotherapy). The higher dropout rates for these studies occurred in the more sensitive areas such as refugees and asylum status. Many people dropped out because their refugee camp closed, they disappeared or were transferred. Some dropouts were for the reasons people drop out using different treatments, such as a lack of motivation or trust, psychosocial problems, spontaneous remission and lack of time. In Orang et al. (2018) study, three participants dropped out because of the high intensity of emotions experienced when reliving traumatic memories. It is usually much more common for dropouts to leave because they are experiencing these difficult memories. Something about NET means that they usually continue with the treatment, probably again because of the storytelling nature of the procedure. People like telling stories.

E-NET There is scope for NET to be presented online. At least in part because only a few people have access to appropriate trauma treatment, even using a technique such as NET. With digital developments, it is no longer necessary for therapists to be in the same location as patients. Robjant et al. (2020) presented E-NET. E-NET is eco-friendly and economically viable. E-NET mirrors NET as much as possible, uses live therapists and it is important to obtain the emotional attunement between therapist and patients. The therapist needs to be present to listen to the testimony.

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Ideally, there should be an assistant near the patient in case they dissociate or there is a clinical emergency. If there is no one, then they should provide emergency contact details. E-NET includes: (1) assessment and psychoeducation, (2) lifeline and (3) narrative exposure. Additional requirements for patients include client safety and a confidential space, any medical requirements, emergency phone number and what to do if disconnected (e.g. chat functions and telephone). Include Shut-D in assessment and consider the likelihood of dissociation during treatment, and regularly attend to suicide ideation. The therapist must teach the patient skills to counter dissociation. The lifeline is co-constructed. During exposure, there is an increased use of contrasting past and present, ask patient to delineate seen and unseen physiological manifestations, therapist focuses on bodily expression as well as face, re-orient client to the here and now, for example, plan for the day, etc. For the testimony, the therapist can screen share, directly type modifications (Lifeline – Yourlifeline.NET).

Comparing Narrative Therapy and NET Apart from narrative therapy and NET dealing with different problems in different ways, the key difference between narrative therapy and NET is that the scientific evidence for NET is much stronger, which is why this chapter is much more substantial regarding evidence. As we saw in Chapter 8, the evidence for narrative therapy is weak at best, which is not to say that it doesn’t work, but that the evidence for its efficacy has not been collected. Perhaps because NET is a manualised fixed procedure, the evidence base is good and is growing. The effectiveness of NET may demonstrate that we should be collecting better evidence for narrative therapy, as it is clear that narrative procedures do work. The other problem is that NET is dealing with a specific problem set out in a clear scientific manner, with well-defined concepts and outcomes, whereas narrative therapy is more of a constructionist approach, where the concepts are not so welldefined, sitting outside the medical model, and so it is more difficult to provide evidence.

Conclusion NET has been around for a couple of decades now and has a very good evidence base across a range of different patient groups. It is relatively easy to administer by people who only need limited training, and it works, which is the main thing for any psychological therapy. It works for many

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different kinds of traumatic experience, from war to sexual abuse. The next question we need to ask is whether NET, or an adaptation of NET, could be used in other circumstances. For instance, could it be used to treat generalised anxiety disorders by focusing on the problems faced by people? Could it be effective in the workplace as a means of alleviating stress? Could it be used to help deal with depression? All these problems, and others, are effectively problems relating to the individual narrative and so could, theoretically, be dealt with by developing a more effective narrative. The actual procedure will have to be adapted for specific circumstances, but the overall principle of a formal fixed method of dealing with an ineffective narrative is the same.

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Chapter 10

Narrative Medicine

The sort of disease a person has is much less important that the sort of person that has the disease.

Hippocrates

Narrative medicine has been around as long as medicine has been linked to stories, and as long as people have tried to find explanations for why people are ill. There have always been stories about illness and cures because doctors and patients have attempted to understand the context of the illness or disease, what it means to the patient and the best means of dealing with it. This is as true for explanations relating to the evil eye, miasmas and other medieval viewpoints as it is for today’s stories about the efficacy of drugs, the need for exercise and for good food. The developing relationship between a doctor and patient is a story that changes over time as illnesses and diseases emerge, are treated and are alleviated or lead to chronic problems or death. Sometimes, there is only a short relationship between a doctor and a patient, for instance, when someone sees a specialist to obtain a resolution of a short-term problem. On other occasions, a relationship can last for many years, for instance, between a patient and their local general practitioner (GP). In the latter case, the GP may see the patient numerous times and come to understand not only the illnesses that they bring, but also how the person is psychologically, how they deal with illness and how they are best treated. Patients visit their GP and tell stories about a symptom or concern, the context, how it affects them and why they came to visit the doctor. There are infinite variations in content, the person telling it and how the story is told (coherent, disjointed, incomplete, etc.). This reflects the uniqueness of the person and their experience. Doctors too have own stories, their understanding, the diagnosis being formulated, ideas about causation and management. These derive from the type of training they have received, 133

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the articles they have read, the conferences they have attended, the other doctors they have talked to, the time and resources available and their general philosophy of medicine. The stages of discussion, assessment and diagnosis are followed by the communication of the diagnosis to the patient and the development of a joint narrative between doctor and patient to determine the course of treatment, if any, and the potential time period for the course of the illness and recovery (‘come and see me in a week’s time and we will see how you are getting on’). There are problems with these narratives, problems on both sides. Doctors are trained – at least to some degree – in communication skills and patient-centredness but patients frequently complain doctors don’t listen, appear disinterested, interrupt, make assumptions and do not address their concerns. Patients in hospital may perceive that their consultant is spending more time talking to the other doctors on the rounds rather than to them. Doctors may think – with some justification – that patients would not understand even if the details of the illness were explained to them. Patients believe – rightly or wrongly – that they are experts, that they have a clear idea of the problem and how it should be treated because they have read articles on the Internet which they believe makes them as expert as their doctor partly because they know about their illness because they, unlike the doctor, are experiencing it. Patients may think that doctors do not appreciate that illness can change everything. The experiential aspect of any illness is important, but patients need to recognise that a doctor’s expertise goes far beyond this regarding understanding their scientific and medical knowledge and the more implicit basis of clinical experience. There are endless ways in which miscommunication can and does occur between doctors and patients, and with miscommunication, we have a failed narrative. All these issues concern narrative medicine. In the end, both the doctor and the patient want the patient to be cured. They have the same goal, but often the means to achieve this goal is fraught with difficulties on both sides.

The Arts and Humanities One of the reasons that narrative is not given a more active focus in medicine is because of a focusing of education. Zaharias (2018b) notes that in the nineteenth and early twentieth centuries, the arts were considered essential to a good education, but that has changed. Now there is a more

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narrow focus. Scientists tend not to receive an education in the arts and humanities. This may be because there is more to learn, or for another reason, but it means that the educational background of most people is rather limited. By bringing back arts and humanities subjects into medicine, there can be a return to humanity. There are many advantages to having an education that contains the arts. The arts and humanities tend to encourage people to reflect on their experience rather than just provide a logical response. They enable people to interpret messages in different forms rather than looking for a single ‘correct’ answer, considering different ways of perceiving and understanding. They enable people to better understand the subjective experience of others, to find meanings, to increase tolerance to ambiguity, encourage creativity and the imagination. They help tap into and respond to feelings and emotional responses. They help people distinguish between the objective and the subjective, encouraging the value of both, and consider questions of why, not just how. In sum, an education in the arts enables doctors to think more broadly, and to better take into account the subjective emotional states of the patient. A study by Doukas, McCullough and Wear (2012) explored the role of humanities subjects in medical education, specifically ethics, history, literature and the visual arts. A panel of experts was put together to describe the major pedagogical goals of these subjects in medical education and how they could be integrated into both undergraduate and graduate medical education. They found three key areas. First, that ethics and the humanities attempt to promote humanistic skills and professional conduct in medical practitioners; second, they teach patient-centred skills; and third, they teach critical appraisal and the implementation of medical professionalism.

Narrative Medicine In terms of a subdiscipline, narrative medicine was introduced in the 1990s at Columbia University by Rita Charon and others who argued that medical practice should be structured around the narratives of the patients and the clinicians. Narrative medicine came about because of the reasons given above and because the biomedical model fails to provide a full explanation of doctors’ clinical competence and experience. Charon (2007) first used the term narrative medicine in 2000 to refer to clinical practice fortified by narrative competence – the capacity to recognise, absorb, metabolise, interpret and be moved by stories of illness.

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We can differentiate the study or discussion of how narratives are used in medicine in general terms and the subdiscipline developed at Columbia. The former is an attempt to demonstrate the necessity and practicalities of employing narrative approaches in medicine. The latter is a more formalised approach which attempts to bring together conceptual frameworks and practical clinical methods to improve clinical practice, specifically to improve clinicians’ understanding of their patients and develop the therapeutic partnership (Charon et al., 2016). According to Zaharias (2018a), the healing power of narrative is repeatedly attested but the scientific evidence for this is sparse. We need more research to define the role of narrative medicine, to understand the specific skills required for practice and to determine narrative medicine’s outcomes with respect to illness and disease. The process of how a person talks about their illness, and how the doctor asks questions to aid understanding, is similar to the narratives that have been discussed throughout this book. The account has a plot (what is happening), characters (the patient, the doctor and any other relevant people such as relatives), metaphorical ways of speaking and coherence. Using narratives explicitly in medicine is a way of attempting to deal with the psychological factors relating to illness as well as the physical problem. It attempts to validate the patient’s experience and also to encourage reflection and creativity in the clinician. According to Charon (2006), there are four divides that contribute to the disconnect between the doctor and the patient: 1. The relation to mortality. Illness is unexpected and elicits many emotions, including the fear of death. Patient attitudes are linked to previous and current experiences, doctors have different experiences from patients, a more theoretical and clinical understanding. Patient fear is very real, and it is important that doctors recognise this, and acknowledge the impact it may have on the patient. 2. The context of illness. Doctors view illness as a biological phenomenon requiring medical intervention. Patients view illness in the context of their entire lives. 3. Beliefs about disease causality. Patients don’t have the knowledge of doctors and so their notions of illness and causes can vary widely. This can be particularly affected by the Internet, which makes knowledge – both accurate and inaccurate, accessible and unaccessible – more widely available.

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4. Shame, blame and fear. Patients are often embarrassed revealing intimate aspects of themselves; illness makes them vulnerable. They may blame themselves because the illness may result from past actions. They might blame the doctor because the doctor failed to cure them on a previous occasion. The doctor may be embarrassed to ask personal questions. They may blame the patient for being demanding or for not looking after themselves. When trying to understand the nature of the relationship between the doctor and the patient and the importance of narrative, it is important to explore these four divides. Narrative understanding develops through the interaction between the doctor and the patient and the different perspectives they bring to the situation.

The Clinical Method Medicine relies on both science and clinical judgement, with the science of objective theory, research and measurement and clinical proficiency and judgement (Greenhalgh, 1999), which requires a different, more subtle, expertise that can only be built over time and experience. Another way of putting it might be to consider the integration of objective evidencebased science with subjective narrative experience, demonstrating the limits of objectivity in the clinical method and the need for subjective (at least partly implicit) clinical judgement. The clinical method is an interpretive act which draws on narrative skills to integrate the various stories told by patients, clinicians and test results (Greenhalgh, 1999). The stories of scientific evidence should be added to that list. A good clinician is someone who, over time, accumulates knowledge (evidence), experience with patients and experience with illness scripts. These are all stories that integrate into the story of the clinician. The success of the narrative paradigm is when the clinician successfully integrates these elements and becomes an expert (though always with limitations and room for error and misinterpretation – human stories are never perfect!). This involves implicit as well as explicit processes, and the clinician will not be able to recall all the patient stories they have heard over time, but each new patient story draws on the wealth of expertise in terms of evidence, experience with patients and illness scripts. Clinical judgement is a good example of how knowledge can be implicit, how an individual may be unable to make the knowledge explicit, to describe it fully to another person. In other words, elements of the clinical narrative are

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implicit and unexplainable. This has huge implications for the functioning of a health-related organisation, where managers may seem to think that productivity is always measurable. Expertise is not always measurable. While doctors apply scientific principles to their work, using the best data available, they do not always have the answers, they cannot always save a life or cure a disease and the work they do has to fit in with the life narratives of the people they are treating. If someone has a life-changing illness or accident, then they will have to adjust their life narrative accordingly and the doctors who are treating them, while making every attempt to effect a cure, a reconstruction or just attempting to make the future as comfortable as possible, should help them through this process. As Charon and Wyer (2008) note, ‘the question is not simply whether medicine is instrumental or imaginative, or whether it requires compassion along with competence, or whether humanities should be required in the medical school curriculum. It has, rather, to do with the nature of health, the problem of pain, the sources of suffering, and the fact of death’ (p. 296). Clinical decisions are based on trustworthy, or least the best available, evidence by clinicians who use their expert judgement and attempt to take into account patients’ values and personal circumstances. Evidence works at several levels, and the traditional scientific perspective is that randomised controlled trials provide the best evidence and anecdotal stories provide the worst. The reality is that these stories, accumulating over time, enable the practitioner to develop sound clinical judgement, a judgement that considers the scientific evidence, but also – critically – the accumulated wisdom developed through many interactions with patients who, despite the scientific need for precision and the removal of error, are all individuals with different stories. The good practitioner takes these stories into account when forming judgements. This is not to say the stories are more important than the science, but they have a critical role to play in clinical judgement. In reality, clinicians consider both the evidence (which itself is often ambiguous) and the narratives and on the whole do a good job. One without the other would not work. Narratives are part of clinical judgement, and so is evidence-based medicine. According to Charon and Wyer (2008), there are three fundamental tensions in medicine: known/unknown, universal/particular and body/self. Clinical evidence is concerned with what is known and unknown, clinical circumstances integrate the universal and the particular and patients’ values reflect both body and self. Narrative medicine recognises the tensions arising from these issues and provides evidence-based medicine with methods of respecting these three circles of attention.

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Charon and Wyer further argue that narrative medicine, along with literature and related subjects, has informed doctors that life is a story, people have lived experiences, illness unfolds in stories and that clinicians are as much witnesses to suffering as they are ‘fixers of broken parts’ (p. 297). Clinicians are encouraged to write about their experiences, patients can see their medical records and, in some cases, contribute to them, which challenges traditional ideas of clinical practice. Ideas around patient-centred care or narrative medicine are becoming more common.

Power and Decision-Making Mahr (2015) illustrated the potential difference between a doctor making a simple diagnosis of an illness such as pneumonia and the problems associated with assessing a patient’s mental health, for example, their decision-making capacity. Pneumonia has reasonably well-agreed signs and symptoms, so a diagnosis is usually fairly straightforward, as is the treatment strategy. While the treatment of pneumonia has power and authority elements in it, with the doctor being the powerful one with the medical knowledge and the authority to decide on a treatment strategy (a patient can refuse treatment but will usually trust the authority of the doctor), the assessment of whether a patient has decision-making capacity is much more difficult and has far-reaching implications. There is an acceptance of the power of the doctor for what is an agreed physical illness, but this becomes more difficult when there are potential legal implications for the patient. We currently have a doctor-centred approach. Even when there is something as complicated as whether a person can make their own decisions, we generally accept the doctor’s privileged position of power and medical knowledge. We assume there is an objective truth to the doctor’s approach, that they are using reason and are up to date regarding the classification of disorders and the appropriate treatment. It is a very doctor-centred approach. The doctor is almost godlike in their powers. The question is whether this is right or acceptable, and whether it is right or acceptable for some problems but not for others. Most societies do recognise these issues at least to some extent, and it is one reason why there are multidisciplinary teams making decisions about complex medical cases. Having a variety of views can help make the best decision. If there are significant legal consequences of a medical decision, people in many societies will listen to the views of more than one doctor and, depending on the situation, bring the material to court to try and make the best possible decision. It is not just a matter of legality, there are societal norms

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and the personal relationship between the patient and the doctor, the trust the patient puts in the doctor (or not). The underlying question here is whether the patient has expertise to contribute and what the limits are of that expertise. Narrative medicine as practiced by Charon presents a model which insists on the primacy of the patient’s narrative or story in the doctor– patient interaction. The plot, the structure and the style of the patient’s story are at the centre of the clinical encounter. The doctor is no longer the authority figure in the same way. Narrative medicine rejects the authoritarian model, instead recognising disparate but concurrently valid viewpoints. In a sense, the narrative medicine model about the mental state of the patient is more objective than the traditional assessment of capacity. Under the traditional model, the patient, in order to have decision-making capacity, must understand the information they are given about the treatment, appreciate their current medical situation, use reason to make a decision and communicate the choices consistently. It is a doctor-centred approach, but there are problems with this. It assumes that there is a single truth (the patient has decision-making capability or not). There is the imbalance of power – it is difficult to argue with the doctor. There are the inferences made about the patient’s mind, and we know such inferences are often erroneous. Narrative medicine explicitly addresses power issues and recognises that there are multiple versions of the truth. Narratives help provide a personal and meaningful connection. This was understood by Jung who, considering psychoneurosis, talked of understanding the suffering of a human being and that the doctor must provide the healing fiction, what the patient longs for. People are seeking help with their health. What they experience, certainly for complex problems, are not (just) symptom clusters, they include the patient’s expectations, fears and hopes. Narrative provides a core means of given meaning to experience. It acknowledges power. According to Mahr (2015), there is a need to separate the privilege of knowledge (that the doctor has) from the privilege of power (which the doctor need not have). The privilege of knowledge is essential for the doctor, the privilege of power is a social role granted to the doctor by society. Mahr (2015), in the example given, suggests that there should be a narrative assessment of the patient’s decision-making capacity, that there is a need to give equal weight to both the doctor’s and the patient’s narratives. A patient with decision-making capacity will present a narrative that is coherent, acknowledges the doctor’s (possibly different) narrative and the

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doctor’s privilege of knowledge, is consistent and self-authored, flexible and potentially open to new data ideas and interpretation. These elements avoid a covert judgement of the patient’s mental state yet recognises the doctor’s knowledge. It allows for a clear and practical approach to the assessment of decision-making capacity without the hidden problems of the traditional model. While recognising that in the past, the doctor perhaps had too much power regarding medical decision-making, it may be going too far to suggest that there should be an equal balance of power. While patients often need a say in medical decisions, particularly complex decisions where there are several choices to be made and where there may be serious consequences for the patient (whether treated or not), in the end, it is the medical practitioner who has many years of training and experience in dealing with medical problems, and most practical people, both doctors and patients, generally recognise the importance of acknowledging this expertise. This does not detract from the need to keep the patient informed and involved, and the need to develop an effective narrative around the medical ­problem – but the doctor and the patient are not equal partners. The doctor has power because they have knowledge and experience, the patient has power because it is their body that is being dealt with. This is never going to be a balanced power relationship, and to complicate it further, the type of power held by the doctor and the patient is different and so difficult to compare, but acknowledging this means that an effective narrative has a better chance of being developed.

Bringing Narrative Medicine to Clinical Practice While Charon may have a clear definition for narrative medicine, others would disagree, which may pose a problem when trying to define the skill set for practising narrative medicine, but researchers and clinicians have proposed ways in which clinicians can begin to actively use narrative in their clinical work. The power of language should not be underestimated (Zaharias, 2018a), and how using language differently can lead to significant changes in the doctor–patient relationship and to clinical practice. To practice narrative medicine, doctors need to have a sense of affiliation, where there is an authentic connection between the doctor and the patient. The doctor needs to develop a sustained habit of clinical reflection. Clinicians strengthen their therapeutic alliances with patients and deepen ability to identify with others’ perspectives. Change is

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not imposed on the patient, but both doctor and patient consider the options so that the patient is empowered, that the clinical situation is co-constructed. A narrative approach fundamentally changes the doctor’s stance by shifting the focus more to the patient, with the doctor listening attentively. The doctor is trying to understand the patient, not just solve the problem. We need a conceptual framework for understanding why narrative skills matter for clinicians and patients. For Rita Charon and her colleagues, the teaching of narrative medicine involves three steps: the close reading of a text, writing about the text (personal reflection and creative writing) and discussing the text and reflection with others. Narrative medicine in this context refers specifically to the training in interpreting literature and applying that skill to understanding patients’ accounts. The key elements are mindfulness, observation and concentration. In writing sessions, participants are invited to describe complex clinical situations, conferring form on chaos, with focus not on what is written, but how it is configured, how the information is turned into a narrative. An alternative perspective was put forward by Launer (2013), who proposed seven Cs for conversations inviting change. These seven Cs underpin his approach to narrative (or narrative-based) medicine. The seven Cs are: 1. Conversations. The patient is encouraged to express themselves in their own words, exploring connections, differences, options and possibilities, which helps facilitate understanding without being controlling. 2. Curiosity. The doctor should show a genuine interest in the patient and want to know more about them and their circumstances. 3. Context. Both the patient and the doctor need to understand the role of family, work, community, beliefs, values, etc., with regard to the patient and their illness. 4. Complexity. Nothing is straightforward. If one thing changes (e.g. change of job, change of drug), then there is a ripple effect to other things. Everything is interconnected. 5. Challenge. The doctor should challenge both themselves and the patient to consider new ideas, examine alternatives, to contemplate change and think about how it might come about. 6. Caution. The doctor should be aware of their limitations and be sensitive to the patient and their needs. 7. Care. The doctor should be non-judgemental and accept patients for who they are.

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Zaharias (2018b) presents practical ways for GPs to start using the skills of narrative medicine and the methods for developing these skills further, including methods for broadening awareness, learning to decipher meanings and developing reflective skills. The arts are a powerful means for gaining these skills, in addition to stimulating the imagination and promoting creativity. Listening, exploring, deciphering and reflecting are tasks which have the common aim of developing joint understanding, ­ultimately ­leading to new narrative that enables and facilitates management. 1. Listening and exploring. This may appear daunting, but it is not difficult. It is like painting a picture, something not completed in one sitting. It is often never finished – revisited, retouched and started again. 2. Deciphering. This is not just about obtaining more information, but finding hidden meanings. 3. Reflecting. Again this is like painting, spending time thinking about the situation. Zaharias (2018b) proposes a number of practical strategies that those interested in narrative medicine should consider employing: – Show interest in the patient – Listen attentively – Do not interrupt, especially at the beginning of the consultation. Let the patient finish their train of thought – Ask open-ended questions – Silence is good – Listen for and follow cues – Observe body language – If the narrative is stopped, perhaps because the consultation has to be terminated, ensure it can continue at next opportunity – View noncompliance as a blocked narrative, not as the product of a difficult patient – Do not make assumptions – Do not be judgemental – Do not be in a hurry to manage the problem – Be mindful of Charon’s four divides (relation to mortality, context of illness, beliefs about disease causality and shame, blame and fear) – If it is not clear why the patient has presented, ask why they are here at this moment with this problem – Reflect questions back to the patient for their opinion

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Zaharias (2018b) also discusses the benefits of practising narrative medicine. In terms of the doctor–patient relationship, this includes improving communication, exposing fear and prejudice, improving and enriching the doctor–patient relationship (e.g. through enhanced trust and empathy) and fostering shared decision-making. Regarding the medical side, it is likely that there will be more detailed medical information available which may improve accuracy or patient history, there will be an increased awareness of how evidence can be interpreted in different ways, how medical errors are made and can be avoided and how medical information is often transient so there is a need to be up to date. Finally, a narrative approach could lead to improved relationships between colleagues, so a more effective health team, and also increased work satisfaction and decreased burnout through increased self-awareness, attention to self-care and the development of resilience.

Criticisms of Narrative Medicine In the first place, narrative medicine is practiced by every doctor who deals with patients. The aim of a consultation is to develop a narrative, to understand the patient’s story. A good doctor will enable the patient to tell their story in a sophisticated manner to ensure that all relevant information is available for assessment and diagnosis. The contribution of researchers in narrative medicine is that it makes the narrative element conscious and detailed. The focus becomes the narrative rather than the diagnosis which aims to help improve the quality of the diagnosis. Providing the explicit skills relating to narrative will enable the doctor to improve their relationships with their patients. There are problems with the narrative approach. Perhaps the biggest of these is time. It takes a long time to bring out a detailed narrative of a person’s life and in practice, most doctors do not have time in their consultations to obtain that level of detail. Nevertheless, in the time available, it is possible to obtain sufficient details of the narrative using narrative techniques. It is an argument beyond the scope of this book to suggest that GPs and consultants should have longer consultations with their patients to improve patient care. Another potential problem is the imbalance of knowledge and power. As we have discussed, part of the purpose of narrative medicine is to give the patient a stronger position in the relationship. The difficulty is, as we see when patients look up information about illnesses on the Internet

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and think they have a sophisticated level of understanding and take this information to their doctor and demand a particular course of action, the patient is often wrong. The knowledge obtained from the Internet by someone not medically trained is limited in a number of ways. Not only is it sometimes wrong, it is often simplistic, and if it is sophisticated, it is unlikely to be well understood by someone not trained in medicine. It gives the patient the illusion of knowledge, which they take to the consultation and the doctor may have to spend valuable time arguing about the validity of the information the patient has. It is important to get the balance right between respecting what the patient is saying and respecting the generally much superior knowledge of the doctor which derives from years of education and usually years of experience. It is usually better for the patient to provide the detailed understanding of their situation than to argue for a particular treatment based on readings from the Internet. This raises the issue of power. Real power is largely in the hands of the doctor. Narrative medicine attempts to change that balance of power so that it is shared. This is a good thing as long as it does not undermine the superior knowledge and understanding that the doctor has about the illness. It is easier to employ narrative medicine when the patient is intellectually capable of rational debate. If their ability is limited, then traditional approaches are likely to be more effective. Charon rejects what she calls the authoritarian model of the doctor– patient relationship, with the doctor being the authoritarian figure who dictates the treatment to the patient on the basis of an assessment and diagnosis. This is an extreme view, and fails to recognise the medical expertise that the doctor brings to the relationship. The best narrative developed between the participants is one of mutual respect and an acknowledgement of the other’s position and understanding.

Conclusion Narrative medicine as a subdiscipline has been dominated by the work at Colombia University in the USA. This chapter has attempted to show that there is a broader approach necessary to incorporating narrative into the relationship between the doctor and the patient, with the patient recognising the importance of the doctor’s medical expertise and the doctor recognising the importance of the patient’s position as the person with the illness and all that implies. An illness, particular a serious illness, is not an isolated experience, it is not divorced from the rest of life. A serious

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illness can impact on all aspects of life, from work to relationships to the future generally. When the doctor is making decisions, they must account for this broader perspective. Of course, for a simple illness that will get better in a few days with a certain drug, this is less important, but with chronic disorders, disabling disorders or disorders that potentially lead to death, the narrative approach can add significant value to the doctor– patient relationship.

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Chapter 11

Narrative Health Psychology

The techniques of narrative interviewing and narrative writing are intrinsic to any discussion of narrative health psychology and these have been looked at in some detail, and the reader will see how they can be applied to their work in health psychology. This chapter briefly presents some examples of where narrative can be and is used in practice. It is surprising that narrative approaches are not used more widely in health psychology, which is focused on helping people deal with physical health-related problems, from serious physical illnesses such as heart disease or cancer through to helping people give up smoking or having a healthier diet. These work best with a narrative approach, particularly because people understand narratives. When people get ill, they turn to stories. They tell stories about their experiences, their symptoms, the perceived causes of the illness and how they will get better. Narratives enable an understanding of the embodied experiences of people from their own perspective, rather than a medicalised version. This also has a wider perspective, the stories can tell of the workings of the medical system (‘I couldn’t get an appointment at my GP’ or ‘I had to wait six months for a consultant appointment’) or the desire for health and longevity (Stephens, 2011). Narrative health psychology functions at various levels (Murray, 2000). At the personal level, it examines the lived experience of the person with a health problem; at the interpersonal level, it involves the construction of narratives between the patient and the doctor, or the patient and the family; at the positional level, it examines the often very different perspectives of the patient and the listener; and at the societal level, there is the concern with narratives that are shared and characteristic of a society (e.g. people in the UK and their mostly positive attitude towards the National Health Service). According to Sools et al. (2015), narrative health psychology is a form of qualitative research in health psychology and a psychological perspective that falls under the interdisciplinary term narrative health research. It is 147

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a small and emerging field and involves studying the lived experience of health and illness through storied accounts of lay people, patients and professionals. It involves taking the voices of patients and professionals seriously. There is more to health problems than being ill, there are people’s strengths to consider, their social connections, well-being, spirituality and imagination regarding the future. Sools et al. (2015) position narrative health psychology in three ways: as a variety of narrative psychology, a form of qualitative research in health psychology and as a psychological perspective under the term narrative health research. They recognise that narrative health psychology is still a small and emerging field but has the capability of breaching mainstream health psychology in terms of approaches, methods and topics. They see the goal of narrative health psychology to provide people with a voice in telling their stories about the lived experience of health and illness. Stories of illness and suffering can be used to successfully understand people’s experiences of health and health care, and not only health itself, but also the social context, perhaps in terms of inequalities and social justice (Stephens, 2011). Kaptein et al. (2015) considered the representation of respiratory disorders by artists. The nature and severity of respiratory disease is typically expressed using biomedical measures – pulmonary function, X-rays, blood tests – but the personal impact of the illness on the patient is reflected in the stories patients tell. Kaptein et al. argue that novels, poems, movies, music and paintings can represent a rich experimental understanding of the patient’s point of view. Examining how illness is represented in art forms may help patients and health care providers cope with illness while at the same time humanising medical care. They argue that it would be beneficial to include art in the medical curriculum.

Using Narrative in Health Psychology: Examples While narrative health psychology is not universal, there are many health psychologists who use a narrative approach. Here are just a few examples. Gunaratnam and Oliviere (2009) edited a book examining narratives in health care, with a focus on people who are seriously ill and dying. They used a multidisciplinary approach to try and understand palliative care from a broad perspective, examining some of the methods and models that can be used in the area, and how practical and ethical dilemmas influence health care. They provide a positive outlook on the importance of stories in palliative care.

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They argue (Gunaratnam & Oliviere, 2009) that stories and narratives are integral to the provision of palliative care, that the holistic nature of the experience is important. This began with the founder of the modern hospice movement, Cicely Saunders. She worked among the dying, collecting stories of illness and pain, turning the patient narratives into a philosophy and practice of holistic caring for dying people. This enabled her to practise medicine in a way to facilitate meaningful connections with patients. She said she was fortunate to be a doctor who wasn’t in a hurry, taking time to get to know her patients. Devery (2009) also examined how narratives might contribute to the evidence base in palliative care. Palliative care should be committed to holistic and person-centred care and so demands multiple sources of evidence. It does not lend itself to a set of clear symptoms and is not accessible to evidence in the form of randomised controlled trials. Providing health care for those who are dying raises profound clinical, psychosocial and ethical challenges and so a broad and complex knowledge is required. There are many factors to consider: psychosocial, family and biomedical. Decisions matter when you are dying. There is a need to consider not only the clinician’s knowledge but also, in particular, the patient’s viewpoint and their narrative, along with evidence across the patient population regarding, for example, mean survival rate over time and disease trajectory (Devery, 2009). Some people want a rapid death. Some want to survive as long as possible. A clinical case study by Mundle (2015) examined pain in rehabilitation therapy in an interview with an 82-year-old female patient in geriatric physical rehabilitation. It provided a detailed example of recognising, assessing and addressing spiritual distress as a symptom of physical pain. It focused on narrative content as well as on the interactive and performative aspects of narrating spiritual health issues in a close reading of two attachment narratives. Mundle argued that we need a narrative turn in healthcare, including exploring the therapeutic benefits of empathic listening through narrative care in geriatric rehabilitation and in healthcare in general. Finally, Papathomas et al. (2015) studied eating disorders in athletes. Most research ignores the families of those with eating disorders, but they are crucial in the management of the problem. The study examined a single case, a 21-year-old elite triathlete who was interviewed along with family members (separately) on several occasions over one year. The interviews encouraged storytelling through an open-ended participant-led structure. Family difficulties arose when personal experiences strayed from culturally

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dominant narrative forms and when family members held contrasting narrative preferences. The athlete’s narrative evolved over the course of illness, but the parents were less malleable. The study found that when family members were constructing different narratives, where there were conflicting narratives, there was frustration, anger and poor communication. Papathomas et al. argue that we need to be aware of how broad cultural narratives impact on the experience of eating disorders. They initially suggested a joint restitution narrative, but this eventually became a source of frustration to all those involved. A narrative therapist needs to recognise if there is a problem of commitment to restitution and could manage expectations by educating people with eating disorders and their families as to the protracted nature of eating disorders. Alternatively, search for alternative narratives to live by, such as a quest narrative, or recognising the eating disorder as a chronic illness that the participants have to live with.

Conclusion These examples provide a brief outline of some of the areas in which narrative health psychologists have worked. There are many others that have not been considered, such as serious chronic conditions such as heart disease or cancer. Narrative approaches may also help where we are looking for behaviour change, such as stopping smoking or improving diet. There is scope for research in all these areas. The future of health psychology will inevitably be largely about narrative health psychology.

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Chapter 12

Narrative Work Psychology

Unlike narrative medicine or narrative health and clinical psychologies, narrative work psychology has a relatively limited profile. There is not much research into the use of narrative in the work context, at least not explicitly, though inevitably much work psychology has narrative elements. This chapter provides examples of how narrative psychology has been used and how it could be used in the future. Narrative psychology can be helpful within the occupational setting. While most occupational psychologists do not use explicitly narrative approaches, there is a growing acceptance of the importance of narrative. One of the benefits of thinking narratively in the workplace is the relationship between individual, interpersonal and group narratives, along with recognising the disparities between the narratives of the worker and the narratives of the organisation (Hunt, 2011). Occupational psychology could more effectively address the impact of these narratives. The traditional disparate narratives of workers and managers, though less important in many workplaces than they once were, are still important in many settings. The traditional drivers of these disparities, that the workers feel that management does not recognise workers’ achievements nor reward good work effectively, and the management view that workers may be lazy or troublesome, may not be as crude as they once were but they still apply across many situations. This is inevitable in a society driven by economy, when the owners (represented by managers) are seen to keep much of the profit for themselves rather than distribute it appropriately to those who do the work. This element of Marxism, the idea of surplus value, may not be popular among many – including occupational and work psychologists – but it does apply, and it is one of the key drivers of enmity between worker and manager. 151

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Examples of the Use of Work Narratives An important element of work is that of identity and identification. When we work for a company, we should (in an ideal world) identify with that company and with its values. This is one element of job satisfaction. We are happier working in a company that we perceive shares the same values as us than one with conflicting values. Narrative is critical here, both at the personal and interpersonal levels and at the more macro or even master narrative levels. If an organisation has an agreed master narrative, then the people who work for it will be more effective, have better job satisfaction and lower stress if they approve of and identify with that master narrative. Companies need coherent organisational narratives that employees on the whole accept. To be successful, this narrative must incorporate the desires and needs of the employees. Success is more likely if both the employer and the employee are being satisfied with the narrative. People generally want to identify with the organisation they work for. Humphreys and Brown (2002) suggest that this identification with an organisation works at several levels. First, an organisation’s identity narrative evolves over time and participants identify with it in various ways. Second, we need to understand how the individual-collective identification process works and evolves. Third, managers play a key role in legitimising organisational and individual identity. Humphreys and Brown, using the example of an institute of higher education trying to develop university status, show how senior managers tried to redefine the identity of the institute and the problems they faced along the way. They found that senior managers had less power than they initially thought regarding the change of identity, so the master narrative of the institute was not malleable in the ways they thought, showing that the organisational identity consists of ongoing dynamic processes driven by power and legitimacy. In the end, senior managers could not simply ride roughshod over the often complex narratives extant in the institute, for instance, views about being locally focused, teaching-led and student-focused being overridden by university values such as research and taking a broader national focus. Simply deleting old values and overwriting them with new values may not be effective because it can alienate those who work in the organisation, who live by those values (Pratt & Foreman, 2000). Where senior managers wish to introduce large-scale changes to the identity of the organisation, they need to consider how the narratives of the workers, how their identities as workers in the organisation, are often closely linked to the master narratives, the values and in the end, the identity of the organisation.

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One study explored narrative in the selection interview, concluding that while behavioural interviews are not conducive to storytelling, where an applicant does produce a narrative response to questions about past behaviour – in 23 percent of the interviews analysed – recruiters will respond positively (Bangerter et al., 2014), perhaps because people enjoy listening to stories. While this study is brief and not conclusive, it does suggest a need to consider the role narratives might play in job selection. Encouraging people to tell stories relevant to the job, particularly about their previous job, might enable recruiters to be better able to select the right people. More broadly, a person’s career as a whole can be considered in narrative terms. Bujold (2004) described how we can see career as narrative. The classic approach to career attempts to match a person’s attributes with ‘suitable’ careers. While this can work very well, understanding career is more complex and nuanced. Career choice and development require numerous decisions, there are many risks, limitations and opportunities, and each individual has different ways of dealing with these, and with unforeseen events, personal circumstances and obstacles. This is a creative process that is at least partly unpredictable. Some people have highly planned careers. For instance, at my son’s school, there were children at the age of 11 who had already decided to be accountants or solicitors (which brings in external motivators regarding career choice, in particular parents!). Other people have careers that appear more random, unplanned or ill-thought out. Careers may be more or less satisfying. They may follow a predicted course or an unpredicted one. What once led to high job satisfaction suddenly becomes tedious. With all these complications, the narrative approach is likely to present a good theoretical and practical solution to understanding career. Identity is critical to career. Along with our personal identities, we have career identities. It is very common to ask someone we have just met, ‘What do you do?’ as though work is central to the core of identity (‘Tell me about yourself’ seems a little strange and intrusive – at least in the UK). Bujold (2004) suggests that a constructionist approach can help us conceptualise career through narrative. Constructionism is primarily about the individual (rather than social constructionism which is about interactions and social discourse) and can be helpful in understanding career narratives. The work of Kelly (1955) on personal constructs is important. Constructs are representations of the world, ways of interpreting the world, that is, the perceived world is not just a series of events but how we construe these events. These constructs are important in helping us make career choices as

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it involves our constructs about ourselves and our constructs about particular careers and expectations of particular careers, and how these constructs match. We interpret our work using constructions and that narratives are relevant for career choice as they provide a means of articulating needs and goals and for examining life patterns (Savickas, 2001). Using narrative in career and career choice inevitably has implications for the practice of careers, for how career counsellors discuss options with people. Narrative-focused career counsellors are facilitators of the meaning-making process, enabling clients to make sense of what they want from their career. Cochrane (1992) notes the importance of Kelly’s constructs in narrative career development. He notes that by engaging in a career project, a person can construct various elements that can be integrated to guide a future career. In this sense, the counsellor will co-author the person’s intended life story. Lainé (1998) discusses how starting or changing a job, being unemployed or retiring are experiences that allow people to reconstruct who they are, who they were and what they aspire to. Through these processes, we can undergo many transformations throughout life. Narrating life is a way of constructing one’s identity. Lainé suggests that autonomy is related to the degree to which an individual identifies their dependences, and narrative helps with this explanation. Again, we have narrative as related to the construction and development of identity. Cochrane (1992) suggests narrative is a paradigm for career research because story reflects human reality in the sense that life is lived and made comprehensible through story. Critically, in order for narrative to be important for career, meaning must be the central subject of a career, that is, distinguishing between a job, just earning money because one has to in order to live and actively choosing a career because it provides meaning in life. This raised the question of what is a good career, a question that will undoubtedly be answered in many different ways by people depending on their perspective on life. In my work (Hunt, 2011), I have examined the utility of a narrative approach in the field of staff appraisal. As above, this entails examining the narratives of the people who work in the organisation and the master narrative of the organisation itself. Two key elements in a successful organisation are production and job satisfaction. An organisation needs to produce whatever it produces and its personnel need to be satisfied with their jobs. Appraisal can play a large part in this by examining and ensuring the fit between the needs of the employees and the needs of the organisation; in other words, the narratives of the employees and the organisation, respectively.

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Traditionally, staff appraisal has, largely through performance ratings, examined the performance of the workers and (possibly) explored how the workers’ performance can be improved, either through threats or incentives. A more sophisticated approach using narrative will enable the employer to understand how the workers narrate their experiences of the workplace, examine whether there are differences between those narratives and the master narrative of the workplace and find ways to narrow the gaps. This might be as straightforward as recognising that employees are not receiving a fair share of the profits of the organisation, it might be regarding working conditions or hours or it might be problems between colleagues. Obtaining narratives from employees in the appraisal situation can help identify where these problems lie and enable people (workers and managers) to find ways to address them. The 360-degree appraisal is a useful tool for obtaining narrative feedback. Gillipsie et al. (2006) used experts to code narrative comments, finding that comments provided by supervisors and subordinates were clearer than those provided by peers, which has implications for such appraisals, that is, whether it is worth obtaining peer comments, or whether they should be obtained in a different way. Smither and Walker (2004) found a link between the characteristics of comments provided by direct reports and later performance. Basically, the number and specificity of the comments had the most effect. These studies suggest that appraisals should make more effective use of narratives, that appraisal systems should be based not only on performance ratings (where they are relevant) but also on detailed and specific comments by colleagues, whether they are supervisory or subordinate. Appraisal systems should be designed around obtaining these narratives more effectively. Brutus (2010) examined the literature around narrative comments in appraisal, concluding that narrative appraisals can profoundly alter the structure of traditional appraisal systems, particularly the ways performance information is collected and presented to participants. Narrative comments in an appraisal can play a very important part in appraisal systems. Further research is needed to examine whether it is sufficient to collect qualitative comments or whether more profound changes might be more effective in matching the narratives of the employees and the organisation. For instance, Boudens (2005) looked at emotions at work using a narrative perspective, to identify clusters of emotions associated with prototypical work situations. She argued that narrative analysis was the best way to explore this topic. At another level, Scott (2019) examined how people make sense of their work, how they develop meaning using narratives. These examples and others

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(e.g. relating to stress, appraisal and performance) will build a picture of how we can use narratives in the workplace across a range of situations, from understanding the individual through to changing organisational culture (or the master narrative of work).

Conclusion This brief chapter has looked at a few examples, but there is scope for further research and application. In particular, this could involve exploring the nature of master narratives at work, examining how organisations functioning at a macro level could provide insights into why some organisations are dysfunctional, perhaps because the aims and norms of employers and employees conflict. Designing organisations to reduce this conflict could have significant benefits both in terms of organisational efficiency and job satisfaction. In addition to this, narratives regarding people’s career choices could provide insight into what it is to obtain a successful job or otherwise – something further explored in Chapter 13, on coaching. Finally, explaining many of the concepts used in organisational psychology, from job satisfaction to stress, in terms of narrative, would also provide insights and the means to improve the functioning of organisations. This is not a job in progress but rather a job that has hardly progressed. Employers and researchers take note.

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Chapter 13

Narrative Coaching

The field of coaching has expanded enormously over the last few decades. It is one of the relatively rare areas of psychology where the focus is on positive outcomes rather than resolving negative problems. There seems to be as many definitions of coaching as there are coaches. The purpose depends on the coach’s perspective, the style of coaching and who is being coached and why. Fundamentally, coaching is about conversations between two people, where one person (the coach) is attempting to influence the other person’s (the coachee) understanding, learning and behaviour in some way (Starr, 2016). This is a little vague, as it does not specify who is being coached nor the specific coaching techniques that are being used. What is common to most coaching is that the coach does not offer advice, but enables the coachee to think through the issues themselves and come up with a solution. Coaching is about becoming rather than being, developing a meaning, a purpose, whether at work or in one’s personal life. Coaching should nurture development and growth in people, and this is where it links with narrative. Over an often fixed period of time, the coach facilitates enquiry and discussion through listening to the coachee, questioning them and providing feedback. The end of the process is that the coachee has (hopefully) changed the way they think about whatever the topic of the coaching is, for example, how to work better, how to manage their time, create a better work–leisure balance and so on. The coachee should have increased their clarity of thinking and thought about how to act with regard to the future, how to change their behaviour and perhaps their thinking patterns. Coaching is both complex and simple. It is complex because it is focused on the richness of human relations and the ways we try and support one another, yet simple in that it is a demonstration of the richness of relationships and the positive elements of what it is to be a person (van Nieuwerburgh, 2017). Coaching refers to how we unlock the potential of a person to maximise their 157

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own performance (Whitmore, 2009). Du Toit and Reissner (2012) suggested that coaching is the ability to increase and improve the sensitivity and awareness that the coachee has within him/herself. A critical component of this is honest feedback, which might be difficult to obtain at both an organisational level, though most coaching is at the individual level.

Coaching Theory and Method There are numerous approaches to coaching which do not really merit the term ‘theory’, which is where we come back to the problem with some other narrative approaches, an appealing looking description of the world and how to deal with it, but limited research support. The difficulty with coaching is that it is difficult to test, to prove or disprove, which means it is not theoretically coherent. Often the best way we can determine the usefulness of an approach is to ask the coachee whether they think they have benefitted from coaching. The problem with this is that the coachee does not provide the best data. As discussed earlier in relation to narrative therapy, the Hawthorne Effect may be present, whereby the coachee feels better simply because they have received attention rather than it has made any difference. They may also think that they have benefitted because the coaching cost money – and who wants to waste money? There are relatively few studies that effectively demonstrate the validity or otherwise of coaching. That is not to say coaching has no benefits, just that it is difficult to establish those benefits to an appropriate level of scientific proof. As Theeboom et al. (2014) noted, there is very little good research on the effectiveness of coaching. In the end, all coaching techniques are about narrative; they are designed to change a person’s narrative in a positive manner. We have seen throughout this book the variety of techniques used by psychologists and others when dealing with the problems people face in life, and coaching is no different. One of the most popular approaches to coaching is the GROW model, which was introduced in the 1980s (Whitmore, 2009). It has been argued that GROW is a proven model (Mukherjee, 2014), though this is debatable. There are four stages to the theory, Goals, Reality, Options, Ways Forward (I always worry that when people try to create neat acronyms, it is to cover up inadequate theory), which refer to the stages that the coachee must go through to create fundamental change. The first stage is establishing the coachee’s goals. It is important to do this at the outset so there is a clear aim. The goals should be SMART (specific, measurable, acceptable, realistic, timely – another example of the acronym problem). The second stage is reality, where the coachee discusses the situation as it is now. The

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third stage is exploring the options that may be available, and the final stage is selecting the best option to move forward. At each stage, there must be a full and frank discussion so that the coachee becomes aware of what they want, what is the current situation, what are the possibilities and which possibilities are chosen to act on. GROW is a narrative technique because it is explicitly working to help the coachee move from one life story to another. The coachee has a life story that they are not happy with and wish to change. The coach enables them to develop and change that life story so it is one they are more happy with. As long as they act on the changes suggested, then, so the theory goes, they will become happier and more fulfilled.

Narrative Coaching We could examine other approaches to coaching, which all have the same problem regarding evidence, but this is a book on narrative. The person who has written more on the subject is David Drake, particularly with his book, Narrative Coaching (2018). There is little real scientific evidence that it works, which is not to say it doesn’t work, it is just that the current evidence is limited. Drake is ambitious in his hopes for narrative coaching, arguing that it relates to self-defining memories that have emotional power. ‘Narrative coaching is designed to help people de-stigmatise these memories, ­de-energise them as reactive behaviours, and de-couple them from their identity. In doing so, they are deconditioning their neural circuitry to create more space for learning, change and growth’ (Drake, 2018, p. 39). The first thing someone does within narrative coaching, according to Drake, is to reflect on a recent experience that is relevant to the issue they are working on, and then to rewind the narration to help them construct a new way of framing the experience, what is the story, how they see themselves, how they change and what outcomes they want. Fundamentally, the narrative coach uses the coachee’s stories as the resource for change. A basic narrative coaching model has four stages: 1. Situate (what is going on?) Finding out what is true for the individual, their explanations. 2. Search (what if?) What does the person really want? What kinds of experiences would they like to have? Obtaining greater clarity about the coachee and their situation.

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3. Shift (what matters?) What matters most in terms of what they want to try. At this stage, it is not only the story but also the key characters who are important. 4. Sustain (what works?). What works for the coachee? What do they need to sustain their changes? This model is similar to many models of coaching and does not present a specifically narrative way of doing coaching. Drake does claim that stories are at the core of what it is to be human and that his approach draws on five important domains: 1. 2. 3. 4. 5.

Anthropology Learning and development Jungian psychology Mind and body Narrative practices

Again, this does not make his approach specifically narrative in style, and indeed, Drake does acknowledge that narrative coaching does have elements in common with other coaching approaches, and also with various forms of therapeutic practice. This is because in the end all coaching is narrative coaching, replacing one story with another. Where Drake does present a specifically narrative approach is to state that narrative coaches invite people to: –  –  –  –  – 

Experience and reflect on their ‘movies’ (stories) Realise that any story they choose is but one alternative Explore new stories that will enable them to flourish Notice old stories in which they are stuck Reconfigure key elements so they can tell new ones

These are the key elements for ensuring that we are doing narrative coaching rather than any other sort of coaching. There is the acknowledgement that people are living by a particular story that they believe is not the most effective one (otherwise why are they visiting a coach?) and that there are alternatives for them to explore, with the aim of changing the old story for a new, better one. Through this process, the person must not only change their story, they must also show how they can change their behaviours to live with this story and so change their lives for the better. Drake uses a number of questions to unpack how people see the world.

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Why this way of seeing things? What do you gain by seeing it this way? What do you lose by seeing it this way? How else could you see it? What other perspectives might you take? What keeps you from considering these possibilities? What might you gain if you did?

These are good, sensible questions to help people think about their current stories and how they might go about changing those stories but take the word ‘story’ out and the questions are simply the type of question any coach might ask, they are not specifically narrative-related. There are a number of problems with Drake’s approach to narrative coaching, which are not criticisms of a narrative approach to coaching per se, but his specific approach. The main one is that there is very little or no evidence of its efficacy, apart from Drake telling us it works. As noted earlier, this is a problem with coaching generally, it is difficult to develop the scientific evidence, partly because many coaches are not scientists, do not work scientifically and at one level do not care about evidence beyond their own beliefs that the approaches they use work, partly because science has not yet developed the means of effectively testing the efficacy of coaching. How do we operationalise the various aspects of coaching? What are the outcome measures? The second problem with Drake’s approach is the way he claims it as his approach. It is not the approach, or a approach, it is as though narrative coaching belongs to him. This does not bode well for narrative coaching as science; science is lost in the mythology of narrative coaching. Drake’s approach is good at bringing in a diverse range of psychological theories, which provide a helpful theoretical underpinning to this approach to coaching, but there is no real reason why this approach is specifically narrative coaching any more or less than other approaches. It is similar to arguments made elsewhere in this book. In the end, perhaps because we are storytellers and storymakers, most psychology is about narrative, even though it is not necessarily explicitly narrative.

An Alternative Narrative Approach Drawing on the useful work of Drake, but extending the paradigm a little, we could look at narrative coaching from an explicitly narrative perspective. That is, we explicitly use stories to help the coachee transition from

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one place to another, from one story to another. To do this, we don’t need to draw on a range of psychological perspectives as Drake does, but instead keep it simple. The focus of narrative coaching here is the simple proposition that a person has one story (about life, work, a relationship, whatever is the focus of the coaching) and they want to change that story. While everything that is suggested here is part of normal coaching practice, throughout the process the person is encouraged to think about their stories. The process is carried out through a series of coaching sessions, that are a little like the interviews that were discussed in earlier chapters. The stages are as follows: 1. The first interview focuses on the world as the person sees it now. This takes into account all important factors. For instance, if the coaching experience is about work, then the person will describe their job, the tasks they carry out, their feelings regarding these tasks and so on. They will also be asked about other aspects of their lives that are affected by their work. This might be anything from spending time commuting to turning to alcohol because they are unhappy, or the impact on their relationships with partners, children and so on. The aim is to get the story as detailed as possible, drawing on the coachee’s behaviours, feelings and thoughts. 2. This is written out as a story and is used as the basis for the next discussion. 3. On the basis of the story, the coachee reviews the elements and determines which parts should be changed. 4. The coachee is encouraged to think about the kinds of changes they want to make, what the alternatives are and so on. 5. The new story is constructed by the coachee making decisions about how to go about making the changes that are required, deciding explicitly what needs changing, how and when. This might mean looking for a new job (what type of job?), or it might mean changing the hours of work, dealing with the workload, discussing the actual workload with the manager and so on. These changes are of course decided by the coachee in discussion with the coach. 6. The coachee makes the changes and at a future date reviews these changes in line with their story, making changes as appropriate, for example, that certain elements could not be changed or were changed differently. This becomes the new story. The important point about this process is that it is all about stories, telling stories, creating stories and at all points, the coach is involved with

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the development of these stories through the conversation, so telling and making stories is carried out in the normal way, with an active audience. This approach is not proposed as a novel and tested way of conducting coaching experiences, but as a means of demonstrating how a narrative approach to coaching might work. For coaching to be narrative coaching, it must focus on stories, storytelling and storymaking. It is hoped that this is just an early stage in developing an effective narrative approach to coaching that will eventually have evidence of effectiveness.

Conclusion While narrative coaching is a promising approach, as it fits with how we actually think, in stories, there is a distinct lack of evidence for its effectiveness. This tends to be true for all forms of coaching, despite its popularity, as it is difficult to establish whether it has had a significant impact on a person’s life. It can be said to work at the basic level, that is, that coachees say it helps, and this should not be dismissed. We all have conversations with other people about what we are hoping to do with life, coaches are just formalising the process and taking care over the kinds of questions they ask. Intuitively, it should work. Now we need to establish an evidence base, something I seem to be saying about many narrative approaches.

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Chapter 14

Conclusion

Narrative approaches are slowly gaining popularity. They have many applications within psychology. Indeed, a lot of applied psychology that does not claim to be using narrative does use narrative. That applies to all the practical areas examined. Clinical psychology is an attempt to help people create new and better narratives for their mental health. Health psychology is an attempt to enable people to create new and better stories for themselves in relation to the physical health. While these may not be explicitly narrative, most approaches have narrative elements. I hope that the arguments in the book demonstrate that narrative approaches have numerous benefits within applied psychology, and the methods can be employed to benefit a lot of people in an efficient manner. As I stated at the outset, one of the key benefits of narrative work is that the act of storymaking and storytelling is such a natural process to people that they find narrative work relatively easy compared to other approaches, though this in itself is enough to argue for the use of narrative. Narrative approaches need to be incorporated into general psychological science so we can develop good evidence for its effectiveness. Until now such approaches have largely been under the umbrella of postmodernism and social constructionism. The book attempts to show how we can look at narrative scientifically, and to explore the ways we can improve the evidence for the various approaches.

What Do We Think We Know? We all use narrative. We all tell stories. These stories have an impact on our lives. Narrative as it has been studied in psychology suggests there are real benefits in applying it across a range of situations. I have outlined what we mean by narrative both generally and within psychology, briefly explored method and analysis (life interviews, narrative writing and narrative therapy) and then argued for a range of narrative approaches, including 164

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narrative exposure therapy (NET), narrative medicine, narrative health psychology, narrative work psychology and narrative coping. Clinical psychology is covered by narrative therapy and NET. There are many topics not explored in the book but there should be sufficient information for the interested reader to explore these areas. I have not looked at developmental psychology from a narrative perspective. I have barely touched narrative neuroscience. These and other areas do need greater attention.

What Is the Evidence? I would like to see narrative firmly within the scientific paradigm, creating testable theory, designing well-controlled studies and developing a solid evidence base. There is no reason narrative cannot become central to scientific psychology. Indeed, people can only benefit from the transition from the postmodernist to the empirical base, drawing on effective theory. There are significant benefits not only for applied narrative psychology but also general psychological theory. NET is a good example of how narrative can have a strong empirical base. The difficulty lies in evidence for the theoretical, methodological and practical utility of the approach. Theoretically, there is disagreement among researchers regarding the nature of narrative. This is not inherently a major problem, as this is the case throughout psychology. Methodologically, there is no real agreement regarding how narratives should be used and how they should be analysed. In terms of application – the heart and purpose of this book – while there is good evidence for some narrative approaches, many approaches, such as narrative therapy or narrative coaching, have limited evidence in support of them. On the plus side, there is also no good evidence suggesting they don’t work. It is important to carry out research into these areas to rectify this. Narrative exposure therapy (NET) is a key exception that has gone mainstream in the last few years. NET has a strong theoretical grounding, a clear method and application and very strong evidence regarding its efficacy. NET is effective at treating post-traumatic stress disorder (PTSD) and trauma. There is also a lot of evidence around expressive writing. Pennebaker and his colleagues, and many researchers around the world, have used expressive writing with various groups and under different conditions. While the evidence is not conclusive, it does suggest that the technique does work under particular conditions and can lead to a significant benefit for those who use it. While the evidence for other approaches is not as strong, that which does exist suggests that we should be continuing with our research and

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hopefully we will see that they work. One of the problems is that not all narrative approaches lend themselves to using standard randomised controlled trials (RCTs) to assess utility. For an RCT to be effective, we need clear outcome measures based on sound theory and methods. Narrative theory, for instance, is difficult to assess using RCTs because it is not dependent on accepted classifications of mental disorders (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)). Instead it is based on the individual client’s definition of their problem. This should not stop researchers from determining the success or otherwise of narrative therapy, but it is not enough to ask clients whether it has worked because they are likely to say yes because they have put time and money into it. We need measures of the problems they define which we can employ pre- and post-treatment. We can use standard measures of depression, anxiety and so on because they are the accepted norm. Narrative therapists can work with current theory, expanding on ICD/DSM definitions by continuing to encourage clients to think about how they define their own problems, and looking at these in relation to ICD/DSM definitions. This may be helpful in providing more sophisticated explanations than ICD/DSM currently provide. This also enables direct comparisons to be made between different forms of therapy. Similar arguments apply across many areas of applied narrative psychology, including health and work psychology. One area of difficulty is that of narrative coaching. The problem here is not specific to narrative coaching, but to coaching generally. How can we assess the efficacy of coaching? How can we know that the coaching procedures we use are working? It is similar with narrative therapy. We can draw on standard measures to determine outcome. If a person is dissatisfied with their career and part of the problem is stress, we can measure stress levels at the outset of coaching and some time later when the results of the coaching have been applied and – perhaps – the person has changed the nature of their job. One of the problems with applied narrative psychology – and with other approaches to resolving psychological problems – is that we are not good at differentiating who will benefit from it. We are aware that therapies such as cognitive behaviour therapy work for some people and not for others. The same is likely to be true for narrative therapy. Based on the evidence, it is also true for expressive writing. This failure to select the right clientele applies across most areas of applied psychology generally. In terms of narrative, some people like to speak or write about their problems, broadcasting them to others or just throwing away their writing, but others prefer to keep things to themselves and

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not talk about them. Throughout psychology, we are poor at differentiating these groups. The problem is not so much that we cannot assess the value of these empirical approaches, it is sometimes that the practitioners are loathe to employ them as they prefer to stand outside the mainstream. This is another argument for bringing narrative into the mainstream, instead of accepting the zealotry that sometimes comes with the subject, the idea that narrative works because it must work. We are all guilty of these kinds of thoughts. Whatever our favoured approach, we like to believe it works. That is not good enough, we need the hard evidence to show that it works. I too believe that narrative approaches can work, in the right way, with the right people, but I withhold my judgement until the studies are conducted. Nevertheless, I wish to highlight the potential of narrative, to bring it into the mainstream and to scientifically assess its benefits. The other problem about accepting narrative as a mainstream topic in scientific psychology is the need for clarity regarding narrative methods and analysis. As we have seen, there is disagreement about the right narrative approaches to take given particular circumstances. There is a fundamental problem for many scientists, that narrative analysis is always going to cause trouble as any narrative analysis has a subjective element as it has to be a top-down analysis carried out by people who understand the nature of stories. While some argue for a quantitative narrative analysis, it is not possible to fully conduct a narrative analysis quantitatively and it is arguable that this is not desirable as it would involve losing too much information in the analysis. Tools such as Linguistic Inquiry and Word Count (LIWC) (used with the expressive writing paradigm) are not doing narrative analyses, they are just counting the use of certain words. The nature of narrative lies in the ways in which words are combined. There may be scope for complex computer analyses in the future, but it is not clear whether this will become possible or desirable given the need for human interpretation. It is here we need to reflect on what we mean by science. Many people seem to think science is about using the ‘scientific method’ to acquire understanding and knowledge, whereas it is about acquiring understanding and knowledge in a systematic manner. This does not preclude the use of subjective narrative analyses as long as they are systematic and follow a series of standard rules. Applied narrative approaches may have little support in some parts of the psychological community but in the end they are not that different to other applied approaches. As already noted, all forms of talking therapy are in one sense narrative therapy as they are intended to make people change

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their personal narratives or stories. The difference lies in the techniques that people use. Narrative therapists have a specific set of tools that they employ to help people.

Future Development and Application Where do we go from here with applied narrative psychology? As you will have seen, I am somewhat of an enthusiast for narrative psychology and I would like to see it everywhere in psychology. I would like it to be a key theoretical approach within the subject, with other areas such as cognition, etc., subsumed within an overall narrative approach. That is unlikely to happen in the near future. On the positive side, while there are discrepancies, theoretical ideas about narrative are reasonably coherent. Notions of personal and master narratives make sense. They are logical, implicit and accepted. What we don’t know is the detail of how they impact on people’s behaviour. We need to do more work on master narratives, how they link to, for instance, cultural memes, how they link to personal behaviour, how powerful they are and how they may link to the evolution of culture, which requires both a top-down and a bottom-up approach to understanding the relationships between the individual and the master narratives. There is a lot of basic research to do as well as applied research. NET is the best researched approach in narrative psychology. It has an excellent evidence base. Many studies, including systematic reviews, show that it works with people suffering from PTSD. There is scope for using or adapting NET for other problems that people face. Where there are clear environmental links with anxiety and depression, an adaptation of NET might be useful. Narrative interviews have many potential uses beyond those already discussed. Not only psychologists but biographers and historians make extensive use of interviews with relevant people. Drawing on narrative techniques can improve the quality of the information obtained. The narrative life interview (NLI) may help focus attention of the impact of specific events or relationships in people’s lives. We have to be tentative about the NLI because at the time of writing, there are no published studies regarding its use although we have conducted extensive student work with various groups of participants. Sometimes RCTs may not be the most appropriate way of assessing the value of a particular approach. They tend to be crude. They are very useful in the area for which they were designed, medicine, where it is straightforward to conduct a fully controlled study. It is more difficult in any area

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of psychology, as the nature of the experimental method does not easily allow for the complexity of either the participants or the techniques being tested. A person will know if they are in the experimental or control group if the comparison is between having a therapy and not having a therapy. The therapist will be aware of which group someone is in. It can be quite difficult to ensure the experimenter is blind to the group. The evidence for narratives in applied psychology, in medicine, coaching and elsewhere, is sometimes not meant to be drawn from RCTs, but is based on the broader experiences of the people involved. It is widely accepted that people who work with narratives are confident in the approach, simply because narrative work is what we normally do in life. If we accept the proposition that we are constantly creating stories, manipulating stories and listening to stories, and this is central to human activity, then it is logical that using narrative approaches with applied areas is going to, at least at some level, work. Instead of artificial approaches using cognitive psychology, psychoanalysis, etc., we are using what people use naturally every day of their lives. A narrative approach will make people’s lives better simply because it is normal.

Conclusion Narrative approaches belong to the scientific tradition of psychology. They belong where the theory can be tested, the methods can be tested and the applications can be tested. If they do not somehow fit within this tradition, then what is the point? Any scientific endeavour must involve observation and empirical testing. We can observe that narrative approaches work, and that is a good start, but we need to thoroughly test them to show that they have benefits. We have done this with NET, and to some extent with therapeutic writing (particularly expressive writing), but we have not done it sufficiently with the other areas of applied narrative psychology. Without this testing, without a solid scientific foundation, narrative approaches will not enter the mainstream. This overview of applied narrative psychology has been an introduction to a fascinating and productive area. Psychologists and others who apply narrative techniques may see real benefits from doing so. While it is an area with severe limitations, not least the limited evidence for many of the approaches, the future looks promising.

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References

Abbott, H. P. (2008). The Cambridge Introduction to Narrative. Cambridge, UK: Cambridge University Press. Adler, J. M., & Poulin, M. J. (2009). The political is personal: Narrating 9/11 and psychological well-being. Journal of Personality, 77(4), 903–993. Adler, J. M., Lakmazaheri, A., O’Brien, E., Palmer, A., Reid, M., & Tawes, E. (2019). Identity integration in people with acquired disabilities: A qualitative study. Personality, 89(1), 84–112. Agger, J., & Jensen, S. B. (1990). Testimony as ritual and evidence in psychotherapy for political refugees. Journal of Traumatic Stress, 3, 115–130. Agger, I., Raghuvanshi, L., Khan, S. S., Polatin, P., & Laursen, L. K. (2009). Testimonial therapy: A pilot project to improve psychological wellbeing among survivors of torture in India. Torture, 19, 204–217. Agger, I., Igreja, V., Kiehle, R., & Polatin, P. (2012). Testimony ceremonies in Asia: Integrating spirituality in testimonial therapy for torture survivors in India, Sri Lanka, Cambodia, and the Philippines. Transcultural Psychiatry, 49(3–4), 568–589. Alexander, J., McAllister, M., & Brien, D. L. (2016). Exploring the diary as a recovery-oriented therapeutic tool. International Journal of Mental Health Nursing, 25(1), 19–26. Alghamdi, M., Hunt, N., & Thomas, S. (2015). The effectiveness of narrative exposure therapy with traumatised fire-fighters in Saudi Arabia: A randomised controlled study. Behaviour Research and Therapy, 66, 64–71. Al-Hadethe, A., Hunt, N., Al-Qaysi, G., & Thomas, S. (2015). Randomised controlled study comparing two psychological therapies for post-traumatic stress disorder (PTSD): Emotional Freedom Techniques (EFT) vs Narrative Exposure Therapy (NET). Journal of Traumatic Stress Disorders and Treatment, 4(2). https://doi.org/10.4172/2324-8947.1000145 Allen, W. (2007). Narrative Therapy for Women Experiencing Domestic Violence. London, UK: Jessica Kingsley. Allgood, S. M., Seedall, R. B., & Williams, R. B. (2020). Expressive writing and marital satisfaction: A writing sample analysis. Family Relations: Interdisciplinary Journal of Applied Family Science, 69(2), 380–391. American Psychiatric Association (APA). (1980). The Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: American Psychiatric Association. 170

Published online by Cambridge University Press

References

171

American Psychiatric Association (APA). (2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association. American Psychiatric Association (APA). (2017). Clinical Practice Guideline for the Treatment of PTSD. Washington, DC: American Psychiatric Association. Accessed 4 May 2023: www-apa-org.nottingham.idm.oclc.org/ptsd-guideline/ ptsd.pdf Andrews, M. (2004). Opening to the original contributions: Counter-narratives and the power to oppose. In M. Bamberg & M. Andrews (Eds.), Considering Counter-Narratives: Narrating, Resisting, Making Sense (pp. 1–6). Amsterdam, the Netherlands: John Benjamins. Andrews, M. (2020). Quality indicators in narrative research. Qualitative Research in Psychology. https://doi.org/10.1080/14780887.2020.1769241 Armstrong, P. B. (2019). Neuroscience, narrative and narratology. Poetics Today, 40(3), 395–428. Bakhtin, M. M. (1993). Toward a Philosophy of the Act. Austin: University of Texas Press. Bakhtin, M. M. (2000). The Dialogical Imagination: Four Essays. Austin: University of Texas Press. Bamberg, M. (2004b). I know it may sound mean to say this, but we couldn’t really care less about her anyway. Form and functions of ‘slut-bashing’ in male identity constructions in 15-year-olds. Human Development, 47(6), 331–353. https://doi.org/10.1159/000081036 Bangerter, A., Corvalan, P., & Cavin, C. (2014). Storytelling in the selection interview? How applicants respond to past behaviour questions. Journal of Business Psychology, 29, 593–604. Barthes, R. (1975). An introduction to the structural analysis of narrative. New Literary History, 6(2), 237–272. Bartlett, F. (1932). Remembering: A Study in Experimental and Social Psychology. Cambridge, UK: Cambridge University Press. Billig, M. (1995). Banal Nationalism. London, UK: SAGE Publications. Bochner, A., & Riggs, N. (2013). Practicing narrative inquiry. In P. Levy (Ed.), Oxford Handbook of Qualitative Research (pp. 195–222). Oxford: Oxford University Press. Bolton, G., Field, V., & Thompson, K. (2006). Writing Works: A Resource Handbook for Therapeutic Writing Workshops and Activities. London, UK: Jessica Kingsley. Boudens, C. J. (2005). The story of work: A narrative analysis of workplace emotion. Organization Studies, 26(9), 1285–1306. Boulay, C., Demogeot, N., & Lighezzolo-Alnot, J. (2020). Dispotifs therapeutiques par l’ecriture a l’adolescence: Une revue systematique de la literature [Therapeutic writing practices with adolescents: A systematic literature review]. L’evolution psychiatrique, 85(2), 281–297. Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597.

Published online by Cambridge University Press

172

References

Breen, A. V., & McLean, K. C. (2017). The intersection of personal and master narratives: Is redemption for everyone? In B. Schiff, A. E. McKim, & S. Patron (Eds.), Life and Narrative: The Risks and Responsibilities of Storying Experience (pp. 197–214). New York, NY: Oxford University Press. Brown, C., & Augusta-Scott, T. (Eds.). (2007). Narrative Therapy: Making Meaning, Making Lives. London, UK: SAGE Publications. Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32–42. Bruner, J. (1986). Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press. Bruner, J. S. (1990). Acts of Meaning. Cambridge, MA: Harvard University Press. Bruner, J. (1991). The narrative construction of reality. Critical Inquiry, 18(1), 1–21. Brutus, S. (2010). Words versus numbers: A theoretical exploration of giving and receiving narrative comments in performance appraisal. Human Resource Management Review, 20(2), 144–157. Bujold, C. (2004). Constructing career through narrative. Journal of Vocational Behaviour, 64(3), 470–484. Burnell, K., Coleman, P., & Hunt, N. (2006). Falklands war veterans’ perceptions of social support and the reconciliation of traumatic memories. Aging and Mental Health, 10(3), 1–8. Burnell, K., Coleman, P., & Hunt, N. (2009a). Coping with traumatic memories: Second World War veterans’ experience of social support in relation to the narrative coherence of war memories. Aging and Society, 30(1), 57–78. Burnell, K., Hunt, N., & Coleman, P. (2009b). Developing a model of narrative analysis to investigate the role of social support in coping with traumatic war memories. Narrative Inquiry, 19(1), 91–105. Burnell, K. J., Coleman, P., & Hunt, N. (2010). Coping with traumatic war memories: Second World War veteran’s experiences of social support in relation to the narrative coherence of war memories. Ageing and Society, 30(1), 57–78. Campbell, J. (2018). The Mythic Dimension: Selected Essays 1959–1987. A. Van Couvering (Ed.). Livingstone, NJ: The Joseph Campbell Foundation. Carlson, R. (1988). Exemplary lives: The use of psychobiography for theory development. In D. P. McAdams & R. L. Ochberg (Eds.), Psychobiography and Life Narratives (pp. 105–138). Durham, NC: Duke University Press. Carroll, J. (2022). Narrative theory and neuroscience: Why human nature matters. Evolutionary Studies in Imaginative Culture. https://doi.org/10.26613/ esic/6.2.301 Cashin, A., Browne, G., & Bradbury, J. (2012). The effectiveness of narrative therapy with young people with autism. Journal of Child and Adolescent Psychiatric Nursing, 26(1), 32–41. Chamberlain, K. (2011). Commentary: Troubling methodology. Health Psychology Review, 5(1), 48–54. Charon R. (2006). Narrative Medicine. Honoring the Stories of Illness. New York, NY: Oxford University Press.

Published online by Cambridge University Press

References

173

Charon, R. (2007). What to do with stories: The sciences of narrative medicine. Canadian Family Physician, 53(8), August, 1265–1267. Charon, R., & Wyer, P. (2008). The art of medicine: Narrative evidence based medicine. The Lancet, 371(9609), 296–297. Charon, R., DasGupta, S., Hermann, N., Irvine, C., Marcus, E. R., Colsn, E. R., Spencer, D., & Spiegel, M. (2016). The Principles and Practice of Narrative Medicine. Oxford: Oxford University Press. Chatman, S. (1990). Coming to Terms: The Rhetoric of Narrative in Fiction and Film. Ithaca, NY: Cornell University Press. Christensen, J. P. (2018). The clinical Odyssey: Odysseus’s apologoi and narrative. Arethusa, 51(1), 1–31. Cienfuegos, A. J., & Monelli, C. (1983). The testimony of political repression as a therapeutic instrument. American Journal of Orthopsychiatry, 53(1), 43–51. Cochrane, L. (1992). The career project. Journal of Career Development, 18, 187–197. Colby, B. N. (1973). A partial grammar of Eskimo folktales. American Anthropologist, 75(3), 645–662. Combs, G., & Freedman, J. (2012). Narrative, poststructuralism, and social justice: Current practices in narrative therapy. The Counselling Psychologist, 40(7), 1033–1060. Comer, C., & Taggart, A. (2021). Mind, Brain and the Narrative Imagination. London, UK: Bloomsbury. Cordell, G., & Ronai, C. R. (1999). Identity management among overweight women: Narrative resistance to stigma. In J. Sobal & D. Maurer (Eds.), Interpreting Weight: The Social Management of Fatness and Thinness (pp. 29–47). New York, NY: Aldine de Gruyter. Craft, M. A., Davis, G. C., & Paulson, R. M. (2013). Expressive writing in early breast cancer survivors. Journal of Advanced Nursing, 69(2), 305–315. Cummings, J. A., Hayes, A. M., Saint, D. S., & Park, J. (2014). Expressive writing in psychotherapy: A tool to promote and track therapeutic change. Professional Psychology: Research and Practice, 45(5), 378–386. Curling, P. (2005). Using testimonies as a method of early intervention for injured survivors of the bombing of the UN headquarters in Iraq. Traumatology, 11, 57–63. Delgado, R. (1989). Storytelling for oppositionists and others: A plea for narrative. Michigan Law Review, 87(8), 2411–2441. Den Elzen, K. (2020). Therapeutic writing through the lens of the grief memoir and dialogical self theory. Journal of Constructivist Psychology, 34(2), 218–230. https://doi.org/10.1080/10720537.2020.1717136 Devery, K. (2009). Narrative-based evidence in palliative care. In Y. Gunaratnam & D. Oliviere (Eds.), Narrative and Stories in Health Care: Illness, Dying and Bereavement. Oxford: Oxford University Press. Dignity (2014). Giving Voice: Using Testimony as a Brief Therapy Intervention in Psychosocial Community Work for Survivors of Torture and Organised Violence. Copenhagen: Dignity, Danish Institute Against Torture. Doukas, D. J., McCullough, L. B., & Wear, S. (2012). Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Academic Medicine, 87(3), 334–341.

Published online by Cambridge University Press

174

References

Drake, D. (2010). Narrative coaching. In E. Cox, T. Bachkirova, & D. Clutterbuck (Eds.), The Complete Handbook of Coaching. London, UK: SAGE Publications. Drake, D. (2018). Narrative Coaching: The Definitive Guide to Bringing New Stories to Life. Petaluma, CA: CNC Press. Dunlop, M. A., & Tracey, J. L. (2013). Sobering stories: Narratives of selfredemption predict behavioural change and improved health among recovering alcoholics. Journal of Personality and Social Psychology, 104(3), 576–590. Du Toit, A., & Reissner, S. (2012). Experiences of coaching team leading. International Journal of Mentoring and Coaching in Education, 1(3), 177–190. Ehlers, A., & Clarke, D. M. (2000). A cognitive model of post-traumatic stress disorder. Behaviour Research and Therapy, 15(3), 249–275. Erikson, E. H. (1968). Identity: Youth and Crisis. New York, NY: W. W. Norton & Company. Esala, J. J., & Taing, S. (2017). Testimony therapy with ritual: A pilot randomized controlled trial. Journal of Traumatic Stress, 30(1), 94–98. Ewick, P., & Silbey, S. S. (1995). Subversive stories and hegemonic tales: Toward a sociology of narrative. Law and Society Review, 29(2), 197–226. Fisher, W. R. (1989). Clarifying the narrative paradigm. Communications Monographs, 56(1), 55–58. Fivush, R., Habermas, T., & Reese, E. (2019). Retelling lives: Narrative style and stability of highly emotional events over time. Qualitative Psychology, 6(2), 156– 166. https://doi.org/10.1037/qup0000150 Fludernik, M. (1996). Towards a “Natural” Narratology. London, UK: Routledge. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a selfreport measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9(4), 445–451. Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6(4), 459–473. Foa, E. B., & Tolin, D. F. (2000). Comparison of the PTSD symptom ­scale-interview version and the clinician-administered PTSD scale. Journal of Traumatic Stress, 13(2), 181–191. Foucault, M. (1980). Power/Knowledge: Selected Interviews and Other Writings. New York, NY: Pantheon. Frank, A. (1998). Just listening: Narrative and deep illness. Families, Systems, & Health, 16(3), 197–212. Frank, A. W. (2010). Letting Stories Breathe. Chicago, IL: University of Chicago Press. Frank, A. W. (2012). Practicing dialogical narrative analysis. In J. Holstein & J. Gubrium (Eds.), Varieties of Narrative Analysis (pp. 33–52). London, UK: SAGE Publications. Franzosi, R. (2010). Quantitative Narrative Analysis. London, UK: SAGE Publications. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865.

Published online by Cambridge University Press

References

175

Freedman, J., & Combs, G. (1996). Narrative Therapy: The Social Construction of Preferred Realities. New York, NY: W. W. Norton & Company. Freeman, M. (2004). Charting the narrative unconscious: Cultural memory and the challenge of autobiography. In M. Bamberg & M. Andrews (Eds.), Considering Counter-Narratives: Narration and Resistance. Amsterdam, the Netherlands: John Benjamins Publishing Company. Frisina, P. G., Borod, J. C., & Lepore, S. J. (2004). A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. Journal of Nervous and Mental Disease, 192(9), 629–634. Furnes, B., & Dysvik, E. (2012). Therapeutic writing and chronic pain: Experiences of therapeutic writing in a cognitive behavioural programme for people with chronic pain. Journal of Clinical Nursing, 21(23–24), 3372–3381. Gallagher, S. (2000). Philosophical conceptions of the self: Implications for cognitive science. Trends in Cognitive Science, 4(1), 14–21. Geertz, C. (1973). Thick description: Towards an interpretative theory of culture. The Interpretation of Cultures: Selected Essays (pp. 3–30). New York, NY: Basic Books. Gillispie, T., Rose, D. S., & Robinson, G. N. (2006). Narrative comments in 360 degree feedback: Who says what? Paper presented at the 21st Annual Conference of the Social for Industrial and Organisational Psychology, Dallas, Texas. Ginzberg, K., Ein-Dor, T., & Solomon, Z. (2010). Comorbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans. Journal of Affective Disorders, 123(1–3), 249–257. Goffman, I. (1961). Asylums: Essays on the Social Situation of the Inmate and Other Inmates. New York, NY: Doubleday. Goncalves, M. M., Matos, M., & Santos, A. (2009). Narrative therapy and the nature of “innovative moments” in the construction of change. Journal of Constructivist Psychology, 22(1), 1–23. Gottman, J. M., & Gottman, J. S. (2008). Gottman method couple therapy. In A. S. Gurman (Ed.), Clinical Handbook of Couple Therapy (4th ed., pp. 138–166). New York, NY: Guilford Press. Gottschall, J. (2012). The Storytelling Animal: How Stories Make Us Human. New York, NY: Mariner Books. Greenhalgh, T. (1999). Narrative based medicine in an evidence based world. British Medical Journal, 318(7179), 323–325. Guilfoyle, M. (2018). Storying unstoried experience in therapeutic practice. Journal of Constructivist Psychology, 31(1), 95–110. Gunaratnam, Y., & Oliviere, D. (2009). Introduction. In Y. Gunaratnam & D. Oliviere (Eds.), Narrative and Stories in Health Care: Illness, Dying and Bereavement. Oxford: Oxford University Press. Gutting, G. (Ed.). (2007). The Cambridge Companion to Foucault (p. 36). Cambridge, UK: Cambridge University Press. Gwozdziewycz, N., & Mehi-Madrona, L. (2013). Meta-analysis of the use of narrative exposure therapy for the effects of trauma among refugee populations. The Permanente Journal, 17(1), 70–76.

Published online by Cambridge University Press

176

References

Halvorsen, J. Ø., & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology, 51(6), 495–502. Halverston, J. R., Goodall, H. L., & Corman, S. R. (2011). Master Narratives of Islamist Extremism. London, UK: Palgrave MacMillan. Hammack, P. L. (2006). Identity, conflict, and coexistence: Life stories of Israeli and Palestinian adolescents. Journal of Adolescent Research, 21(4), 323–369. Hammack, P. L. (2008). Narrative and the cultural psychology of identity. Personality and Social Psychology Review, 12(3), 222–247. Hammack, P. L. (2009). Exploring the reproduction of conflict through narrative: Israeli youth motivated to participate in a coexistence programme. Peace & Conflict: Journal of Peace Psychology, 15(1), 49–74. Hammack, P. L. (2010). Identity as burden or benefit? Youth, historical narrative, and the legacy of political conflict. Human Development, 53(4), 173–201. Hammack, P. L. (2011). Narrative and the Politics of Identity the Cultural Psychology of Israeli and Palestinian Youth. New York, NY: Oxford University Press. Hammack, P. L., & Toolis, E. E. (2015). Putting the social into personal identity: The master narrative as root metaphor for psychological and developmental science. Commentary on McLean & Syed. Human Development, 58(6), 350–364. Hare-Mustin, R. T. (1994). Discourses in the mirrored room: A post-modern analysis of therapy. Family Process, 33(1), 19–35. Harre, R., & Gillett, G. (1994). The Discursive Mind. London, UK: SAGE Publications. Harris, A., Carney, S., & Fine, M. (2001). Counter work: Introduction to “Under the covers: Theorising the politics of counter stories”. In M. Fine & A. M. Harris (Eds.), Under the Covers: Theorising the Politics of Counter Stories (pp. 6–18). London, UK: Lawrence & Wishart. Haslam, A., & Reicher, S. (2012). Contesting the nature of conformity: What Milgram and Zimbardo’s studies really show. PLoS Biology, 10(11), e1001426. Heidegger, M. (1971). Poetry, Language, Thought. New York, NY: Harper and Row. Hensel-Dittmann, D., Schauer, M., Ruf, M., Catani, C., Odenwald, M., Elbert, T., & Neuner, F. (2011). Treatment of traumatized victims of war and torture: A randomized controlled comparison of narrative exposure therapy and stress inoculation training. Psychotherapy and Psychosomatics, 80(6), 345–352. Herman, D. (2007). Storytelling and the sciences of mind: Cognitive narratology, discursive psychology, and narratives in face-to-face interaction. Narrative, 15(3), 306–334. Hermans, H. J. (2002). The dialogical self as a society of mind: Introduction. Theory and Psychology, 12(2), 147–160. Hermenau, K., Hecker, T., Schaal, S., Maedl, A., & Elbert, T. (2013). Addressing post-traumatic stress and aggression by means of narrative exposure: A randomized controlled trial with ex-combatants in the eastern DRC. Journal of Aggression, Maltreatment & Trauma, 22(8), 916–934.

Published online by Cambridge University Press

References

177

Hijazi, A. M., Lumley, M. A., Ziadni, M. S., Haddad, L., Rapport, L. J., & Arnetz, B. B. (2014). Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: A preliminary randomized clinical trial. Journal of Traumatic Stress, 27(3), 314–322. Hinsberger, M., Holtzhausen, L., Sommer, J., Kaminer, D., Elbert, T., Seedat, S., & Weierstall, R. (2019). Long-term effects of psychotherapy in a context of continuous community and gang violence: Changes in aggressive attitude in high-risk South African adolescents. Behavioural and Cognitive Psychotherapy, 48(1), 1–13. Hochman, Y., & Spector-Mersel, G. (2020). Three strategies for doing narrative resistance: Navigating between master narratives. British Journal of Social Psychology, 59(4), 1043–1061. Hogg, M. A., Meehan, C., & Farquharson, J. (2010). The solace of radicalism: Self-uncertainty and group identification in the face of threat. Journal of Experimental Social Psychology, 46(6), 1061–1066. Holmes, T. (2022). Developing the Narrative Life Interview for Transgender Patients. BMed Project Report, University of Nottingham. Howard, G. S. (1991). Culture tales: A narrative approach to thinking, ­cross-cultural psychology, and psychotherapy. American Psychologist, 46(3), 187–197. Humphreys, M., & Brown, A. D. (2002). Narratives of organisational identity and identification: A case study of hegemony and resistance. Organisation Studies, 23(3), 421–447. Hunt, N. (2004). The contribution of ‘All Quiet on the Western Front’ to our understanding of psychological trauma. European Psychiatry, 19(8), 489–493. Hunt, N. (2010). Memory, War and Trauma. Cambridge, UK: Cambridge University Press. Hunt, N. (2011). Setting Up and Running Effective Staff Appraisals and Feedback Review Meetings. Oxford: How To Books. Hunt, N., & Robbins, I. (2001). World War Two veterans, social support, and veterans’ associations. Aging and Mental Health, 5(2), 175–182. Jaaskelainen, I. P., Klucharev, V., Panidi, K., & Shestakova, A. N. (2020). Neural processing of narratives: From individual processing to viral propagation. Frontiers in Neuroscience, 14, 253. Jacob, N., Neuner, F., Maedl, A., Schaal, S., & Elbert, T. (2014). Dissemination of psychotherapy for trauma spectrum disorders in postconflict settings: A randomized controlled trial in Rwanda. Psychotherapy and Psychosomatics, 83(6), 354–363. James, W. (1890). The Principles of Psychology (Vol. 1). New York, NY: Dover. Jameson, F. (1981). The Political Unconscious: Narrative as a Socially Symbolic Act. Ithaca: Cornell University Press. Janoff-Bulman, R. (2010). Shattered Assumptions. London, UK: Simon and Schuster. Jørgensen, M. M., Modvig, J., Agger, I., Raghuvanshi, L., Khan, S. S., & Polatin, P. (2015). Testimonial therapy: Impact on social participation and emotional well-being among Indian survivors of torture and organized violence. Torture, 25(2), 22–33.

Published online by Cambridge University Press

178

References

Kaptein, A. A., Meulenberg, F., & Smyth, J. M. (2015). A breath of fresh air: Images of respiratory illness in novels, poems, films, music, and paintings. Journal of Health Psychology, 20(3), 246–258. Karibwende, F., Niyonsengo, J., Biracyaza, E., Nyirinkwaya, S., Hitayezu, I., Sebatukura, G. S., … & Mutabaruka, J. (2023). Efficacy of narrative therapy for orphan and abandoned children with anxiety and attention deficit and hyperactivity disorders in Rwanda: A randomised controlled trial. Journal of Behaviour Therapy and Experimental Psychiatry, 78, 101802. Kelly, G. A. (1955). The Psychology of Personal Constructs. New York, NY: W. W. Norton & Company. Kelly, J. (2014). Commentary on Furnes B and Dysvik E (2012) Therapeutic writing and chronic pain: Experiences of therapeutic writing in a cognitive behavioural programme for people with chronic pain. Journal of Clinical Nursing, 23, 2692–2693. Köbach, A., Schaal, S., Hecker, T., & Elbert, T. (2017). Psychotherapeutic intervention in the demobilization process: Addressing combat-related mental injuries with narrative exposure in a first and second dissemination stage. Clinical Psychology and Psychotherapy, 24(4), 807–825. Lainé, A. (1998). Faire de sa vie une histoire: Théories et pratiques de l’histoire de vie en formation. Paris: Desclée de Brouwer. Landless, B. M., Walker, M. S., & Kaimal, G. (2019). Using human and computerbased text analysis of clinical notes to understand military service members’ experiences with therapeutic writing. The Arts in Psychotherapy, 62(5), 77–84. Laszlo, J., Ehmann, B., Polya, T., & Peley, B. (2007). Narrative psychology as science. ETC – Empirical Text and Culture Research, 3, 1–13. Laub, D. (1995). Truth and testimony: The process and the struggle. In C. Caruth (Ed.), Trauma, Explorations in Memory. Baltimore, MD: John Hopkins University Press. Launer, J. (2013). Training in narrative-based supervision: Conversations inviting change. In L. S. Sommers & J. Launer (Eds.), Clinical Uncertainty in Primary Care. The Challenge of Collaborative Engagement (pp. 163–176). New York, NY: Springer. Lely, J. C. G., Smid, G. E., Jongedijk, R. A., Knipscheer, J. W., & Kleber, R. J. (2019). The effectiveness of narrative exposure therapy: A review, meta-analysis and meta-regression analysis. European Journal of Psychotraumatology, 10 (1), 1550344. Leonard, R., & Burns, A. (2006). Turning points in the lives of midlife and older women: Five year follow up. Australian Psychologist, 4(1), 28–36. Lopez, R. T., Goncalves, M. M., Dassnacht, D. B., Machado, P. P., & Sousa, I. (2014). Long-term effects of psychotherapy on moderate depression: A comparative study of narrative therapy and cognitive-behavioural therapy. Journal of Affective Disorders, 167(1), 64–73. Lyotard, J.-F. (1984). The Postmodern Condition. Minneapolis: University of Minnesota Press. Lysaker, P. H., & Lysaker, J. T. (2006). A typology of narrative impoverishment in schizophrenia: Implications for understanding the process of establishing and sustaining dialogue in individual psychotherapy. Counselling Psychology Quarterly, 18(1), 57–68.

Published online by Cambridge University Press

References

179

Mahr, G. (2015). Narrative medicine and decision-making capacity. Journal of Evaluation in Clinical Practice, 21(3), 503–507. Marschack, A. (1972). Roots of Civilization: The Cognitive Beginnings of Man’s First art, Symbol, and Notation. New York, NY: McGraw-Hill. Mazza, N. (2003). Poetry Therapy: Research and Practice. London, UK: Brunner-Routledge. McAdams, D. P. (1996). Personality, modernity, and the storied self: A contemporary framework for studying persons. Psychological Inquiry, 7(4), 295–321. McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122. McAdams, D. P. (2006). The redemptive self: Generativity and the stories Americans live by. Research in Human Development, 3(2–3), 81–100. McAdams, D. P. (2007). The Life Story Interview. Retrieved from The Study of Lives Research Group website https://sites.northwestern.edu/ thestudyoflivesresearchgroup/instruments McAdams, D. P. (2008a). Personal narratives and the life story. In O. P. John, R. W. Robbins, & L. A. Pervin (Eds.), Handbook of Personality: Theory and Research (pp. 242–262). London, UK: Guilford Press. McAdams, D. P. (2008b) The Life Story Interview. Accessed 21 February 2019: www.sesp.northwestern.edu/foley/instruments/interview/ McAdams, D. P. (2015). The Art and Science of Personality Development. New York, NY: Guilford Press McAdams, D. P., & Bowman, P. (2001). When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narratives and their relation psychosocial adaptation in midlife adults and in students. Personality and Social Psychology Bulletin, 27(4), 474–485. McAdams, D. P., Diamond, A., de St. Aubin, E., & Mansfield, E. (1997). Stories of commitment: The psychosocial construction of generative lives. Journal of Personality and Social Psychology, 72(3), 678–694. McAdams, D. P., & McLean, K. C. (2013). Narrative identity. Current Directions in Psychological Science, 22(3), 233–238. McAdams, D. P., & Pals, J. L. (2006). A new Big Five: Fundamental principles for an integrative science of personality. American Psychologist, 61(3), 204–217. McKian, S. S., Rabiei, S., Bemana, H., & Ramezani, M. (2019). Experimental design and statistical evaluation on the effect of narrative therapy on body image and body mass index in Iranian overweight and obese women. Obesity Medicine, 14, 100097. McKinney, F. (1976). Free writing as therapy. Psychotherapy: Theory, Research and Practice, 13(2), 183–187. McLean, K., & Syed, M. (2016). Personal, master, and alternative narratives: An integrative framework for understanding identity development in context. Human Development, 58(6), 318–349. McLean, K. C., & Thorne, A. (2003). Late adolescents’ self-defining memories about relationships. Developmental Psychology, 39(4), 635–645. https://doi.org/ 10.1037/0012-1649.39.4.635

Published online by Cambridge University Press

180

References

Mead, G. H. (1934). Mind, Self and Society. Chicago, IL: University of Chicago Press. Mehl-Madrona, L., & Mainguy, B. (2021). Neuroscience and narrative. Anthropology of Consciousness, 33(1), 79–95. Metcalfe, L. (2017). Solution Focused Narrative Therapy. New York, NY: Springer. Meyer, S. (2015). Double listening and the danger of a single story. Wisdom in Education, 5(2), Article 4. Monforte, J., Pérez-Samaniego, V., & Devís-Devís, J. (2018). The Anabasis of Patrick: Travelling an allegorical narrative map of illness and disability. Psychology, Sport and Exercise, 37, 235–243. Monk, G. (1997). How narrative therapy works. In G. Monk, J. Winslade, K. Crocket, & D. Epston (Eds.), Narrative Therapy in Practice: The Archaeology of Hope (pp. 3–31). San Francisco, CA: Jossey-Bass. Moore, K., Moxley-Haegert, L., & Talwar, V. (2015). Definitional ceremonies: Narrative practices for psychologists’ to inform interdisciplinary teams’ understanding of children’s spirituality in pediatric settings. Journal of Health Psychology, 20(3), 259–272. Mordechay, D. S., Nir, B., & Eviatar, Z. (2019). Expressive writing – Who is it good for? Individual differences in the improvement of mental health resulting from expressive writing. Complementary Therapies in Clinical Practice, 37, 115–121. Morgan, A. (2000). What Is Narrative Therapy: An Easy to Read Introduction. Adelaide, South Australia: Dulwich Centre Publications. Morkved, N., Hartmann, K., Aarsheim, L. M., & Holen, D. (2014). A comparison of Narrative Exposure Therapy and Prolonged Exposure Therapy for PTSD. Clinical Psychology Review, 34(6). https://doi.org/10.1016/j.cpr.2014.06.005 Moscovici, S. (1984). The phenomenon of social representations. In R. Farr & S. Moscovici (Eds.), Social Representations (pp. 3–69). Cambridge, UK: Cambridge University Press. Mukherjee, S. (2014). Corporate Coaching: The Essential Guide. London, UK: SAGE Publications. Mundle, R (2015). A narrative analysis of spiritual distress in geriatric physical rehabilitation. Journal of Health Psychology, 20(3), 273–285. Mundt, A. P., Wünsche, P., Heinz, A., & Pross, C. (2014). Evaluating interventions for posttraumatic stress disorder in low and middle income countries: Narrative exposure therapy. Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas, 12(2), 250–266. Murray, M. (2000). Levels of analysis in health psychology. Journal of Health Psychology, 5(3), 337–347. Neimeyer, R. A., & Raskin, J. D. (2000). On practicing postmodern therapy in modern times. In R. A. Neimeyer & J. D. Raskin (Eds.), Constructions of Disorder: Meaning-Making Frameworks for Psychotherapy (pp. 3–14). Washington, DC: American Psychological Association. Nelson, H. L. (2001). Damaged Identities, Narrative Repair. New York, NY: Cornell University Press. Neuner, F., Schauer, M., Karunakara, U., Klaschik, C., Robert C., & Elbert, T. (2004a). Psychological trauma and evidence for enhanced vulnerability for PTSD through previous trauma in West Nile refugees. BMC Psychiatry, 4(1), 34.

Published online by Cambridge University Press

References

181

Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004b). A comparison of narrative exposure therapy, supportive counselling, and psychoeducation for treating post-traumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72(4), 579–587. NICE (2018). Post-traumatic Stress Disorder: NICE Guideline, Published December 2018. Accessed 21 February 2019: www.nice.org.uk/guidance/ng116/chapter/ Recommendations#management-of-ptsd-in-children-young-people-and-adults Onega, S., & Landa, J. A. G. (Eds.). (1996). Narratology: An Introduction. London, UK: Longman. Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Aldenwald, M., Schauer, M., & Elbert, T. (2004). The Nakivale Camp mental health project: Building local competency for psychological assistance to traumatised refugees. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict, 2(2), 90–107. Onyut, L.P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative exposure therapy as a treatment for child war survivors with posttraumatic stress disorder: Two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5, 7. Orang, T., Ayoughi, S., Moran, J. K., Ghaffari, H., Mostafavi, S., Rasoulian, M., & Elbert, T. (2018). The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence: A randomized controlled trial. Clinical Psychology and Psychotherapy, 25(6), 827–841. Osatuke, K., & Stiles, W. B. (2006). Problematic internal voices in clients with borderline features: An elaboration of the assimilation model. Journal of Constructivist Psychology, 19(4), 287–319. Papathomas, A., Smith, B., & Lavallee, D. (2015). Family experiences of living with an eating disorder: A narrative analysis. Journal of Health Psychology, 20(3), 313–325. Pargament, K. I., Magyar, G. M., Benore, E., & Mahoney, A. (2005). Sacrilege: A study of sacred loss and desecration and their implications for health and well-being in a community sample. Journal for the Scientific Study of Religion, 44(1), 59–78. Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257–301. Pennebaker, J. W. (2018). Expressive writing in psychological science. Perspectives on Psychological Science, 13(2), 226–229. Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), 274–281. Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing and its links to mental and physical health. In H. S. Friedman (Ed.), Oxford Handbook of Health Psychology (pp. 417–437). Oxford: Oxford University Press. Pennebaker, J. W., & Graybeal, A. (2001). Patterns of natural language use: Disclosure, personality and social integration. Current Directions in Psychological Science, 10(3), 90–93.

Published online by Cambridge University Press

182

References

Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243–1254. Pennebaker, J. W., Chung, C. K., Ireland, M., Gonzales, A., & Booth, R. J. (2007). The Development and Psychometric Properties of LIWC2007. Austin, TX: LIWC.net. Pennebaker, J. W., Richards, J. M., Beal, W. E., & Seagal, J. D. (2000). Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates. Journal of Abnormal Psychology, 109, 156–160. Pinker, S. (1997). How the Mind Works? New York, NY: W. W. Norton & Company. Pleh, C. (2020). From the constructive memory of Bartlett to narrative theories of social (Brady Wagoner: The Constructive Mind. Bartlett’s Psychology in Reconstruction. 2017). Culture and Psychology, 26(2), 287–299. Polkinghorne, D. E. (1988). Narrative Knowing and the Human Sciences. New York, NY: State University of New York Press. Pratt, M. G., & Foreman, P. O. (2000). Classifying managerial responses to multiple organisational identities. Academy of Management Review, 25(1), 18–42. Prickett, S. (2002). Narrative, Religion and Science: Fundamentalism versus Irony, 1700–1999. Cambridge, UK: Cambridge University Press Propp, V. (1928/1958). Morphology of the Folktale. Bloomington: Indiana University Press. Raghuraman, S., Stuttard, S., & Hunt, N. (2020). Evaluating Narrative Exposure Therapy for post-traumatic stress disorder and depression symptoms: A metaanalysis of the evidence base. Clinical Psychology and Psychotherapy, 28(1), 1–23. Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., & Shulman, G. L. (2001). A default mode of brain function. Protocols of the National Academy of Science USA, 98(2), 676–682. Ramsey-Wade, C., Williamson, H., & Meyrick, J. (2021). Therapeutic writing for disordered eating: A systematic review. Journal of Creativity in Mental Health, 16(1), 59–76. Randall, W. (2017). The Narrative Complexity of Ordinary Life: Tales from the Coffee Shop. Oxford, UK: Oxford University Press. Reinhold, M., Burkner, P.-C., & Holling, H. (2018). Effects of expressive writing on depressive symptoms – A meta-analysis. Clinical Psychology Science and Practice, 25(1), el2224. Reischer, H. N. (2021). The last chapters of life: A proposed research agenda for studying narrative identity in older adulthood. Social and Personality Psychology Compass, 15(7), e12620. Richardson, L. (2000). Writing: A method of inquiry. In N. Denzin & Y. Lincoln (Eds.), Handbook of Qualitative Research (2nd ed., pp. 923–948). London, UK: SAGE Publications. Richert, A. J. (2006). Narrative psychology and psychotherapy integration. Journal of Psychotherapy Integration, 16(1), 84–110. Ricoeur, P. (1984). Time and Narrative (Vol. 1). Chicago, IL: University of Chicago Press. Ricoeur, P. (1984–1987). Time and Narrative. Vol. I–III. Chicago, IL: University of Chicago Press.

Published online by Cambridge University Press

References

183

Riessman, C. K. (2005). Narrative analysis. In Narrative, Memory and Everyday Life. Huddersfield, UK: University of Huddersfield. Riessman, C. K. (2008). Narrative Methods for the Human Sciences. Thousand Oaks, CA: SAGE Publications. Riordan, R. J. (1996). Scriptotherapy: Therapeutic writing as a counselling adjunct. Journal of Counseling and Development, 74(3), 263–269. Robjant, K., Meyer, D. M., Kaiser, E., Kaltenbach, E., & Schauer, M. (2020). E-NET: Narrative Exposure Therapy online – The challenges and opportunities of delivering trauma therapy remotely. Maltrattamento e abuso all’infancia, 22(3), 69–85. Ronai, C. R., & Cross, R. (1998). Dancing with identity: Narrative resistance strategies of male and female stripteasers. Deviant Behavior, 19(2), 99–119. Rorty, R. (2004). Analytic philosophy and narrative philosophy. Pécs Lecture II. May 4. Rubin, M., Hawkins, B., Cobb, A., & Telch, M. J. (2020). Emotional reactivity to grief-related expressive writing. Death Studies, 44(9), 552–560. Saguy, A. C., & Ward, A. (2011). Coming out as fat: Rethinking stigma. Social Psychology Quarterly, 74(1), 53–75. Sarbin, T. R. (Ed.). (1986). Narrative Psychology: The Storied Nature of Human Conduct. London, UK: Praeger Publishers/Greenwood Publishing Group. Sargunaraj, M., Kashyap, H., & Chandra, P. S. (2021). Writing your way through feelings: Therapeutic writing for emotion regulation. Journal of Psychosocial Rehabilitation and Mental Health, 8(2), 73–79. Savickas, M. L. (2001). Toward a comprehensive theory of career development: Dispositions, concerns, and narratives. In F. T. L. Leong & A. Barak (Eds.), Contemporary Models in Vocational Psychology: A Volume in Honour of Samuel H. Osipow (pp. 295–320). Mahwah, NJ: Erlbaum. Schachter, S., & Singer, J. (1962). Cognitive, social and physiological determinants of emotional state. Psychological Review, 69(5), 379–399. Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy: A ShortTerm Treatment for Post-traumatic Stress Disorders (2nd ed.). Oxford: Hogrefe. Schiff, B. (2013). Fractured narratives: Psychology’s fragmented narrative psychology. In M. Hyvärinen, M. Hatavara, & L. C. Hydén (Eds.), The Travelling Concept of Narrative (pp. 245–264). Amsterdam: John Benjamins. Schiff, B. (2017). A New Narrative for Psychology. Oxford, UK: Oxford University Press. Scott, K. S. (2019). Making sense of work: Finding meaning in work narratives. Journal of Management and Organization, 28(5), 1057–1077. Shannon, T. (2005). Human nature in a post-human genome project world. In H. Baillie & T. Casey (Eds.), Is Human Nature Obsolete? Genetics, Bioengineering, and the Future of the Human Condition (pp. 269–316). Cambridge, MA: MIT Press. Shore, B. (1996). Culture in Mind: Cognition, Culture, and the Problem of Meaning. Oxford: Oxford University Press. Singer, J. A. (2004). Narrative identity and meaning making across the adult lifespan: An introduction. Journal of Personality, 72(3), 437–460.

Published online by Cambridge University Press

184

References

Singer, J. A., Blagov, P., Berry, M., & Oost, K. M. (2013). Self‐defining memories, scripts, and the life story: Narrative identity in personality and psychotherapy. Journal of Personality, 81(6), 569–582. Sloan, D. M., & Marx, B. P. (2018). Maximising outcomes associated with expressive writing. Clinical Psychology Science and Practice, 25(1), e12231. Sloan, D. M., Marx, B. P., Epstein, E. M., & Dobbs, J. L. (2008). Expressive writing buffers against maladaptive rumination. Emotion, 8(2), 302–306. Smith, B. (2013). Disability, sport, and men’s narratives of health: A qualitative study. Health Psychology, 32(1), 110–119. Smith, J. A. (2011). Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review, 5(1), 9–27. Smith, B., & Monforte, J. (2020). Stories, new materialism and pluralism: Understanding, practising and pushing the boundaries of narrative analysis. Methods in Psychology, 2(3), 100016. Smith, B., & Sparkes, A. C. (2006). Narrative inquiry in psychology: Exploring the tensions within. Qualitative Research in Psychology, 3(3), 169–192. Smither, J. W., & Walker, A. G. (2004). Are the characteristics of narrative comments related to improvement in multirater feedback over time? Journal of Applied Psychology, 89, 575–581. Smyth, J., & Helm, R. (2003). Focused expressive writing as self-help for stress and trauma. Journal of Clinical Psychology, 59(2), 227–235. Smyth, J. M., & Pennebaker, J. W. (2008). Exploring the boundary conditions of expressive writing: In search of the right recipe. British Journal of Health Psychology, 13(1), 1–7. Solorzano, D. G., & Yosso, T. J. (2002). Critical race methodology: Counterstorytelling as an analytical framework for education research. Qualitative Inquiry, 8(1), 23–44. Sonnenschein, H., & Lindgren, T. (2020). The shapeshifting self: Narrative pathways into political violence. Religions, 11(9), 464–477. Sools, A. M., Murray, M., & Westerhof, G. J. (2015). Narrative health psychology: Once more unto the breach. Journal of Health Psychology, 20(3), 239–245. Starr, J. (2016). The Coaching Manual: The Definitive Guide to the Process, Principles and Skills of Personal Coaching (4th ed.). London, UK: Pearson. Stearns, P., & Stearns, C. (1985). Emotionology: Clarifying the History of emotions and emotional standards. American Historical Review, 90(4), 13–36. Stenmark, H., Catani, C., Neuner, F., Elbert, T., & Holen, A. (2013). Treating PTSD in refugees and asylum seekers within the general health care system: A randomized controlled multicentre study. Behaviour Research and Therapy, 51(10), 641–647. Stephens, C. (2011). Narrative analysis in health psychology research: Personal, dialogical and social stories of health. Health Psychology Review, 5(1), 62–78. Stockton, H., Joseph, S., & Hunt, N. (2014). Expressive writing and posttraumatic growth: An internet-based study. Traumatology, 20(2), 75. Strauss, A., & Corbin, J. (2014). Basics Qualitative Research: Techniques and Procedures for Developing Grounded Theory. London, UK: SAGE Publications.

Published online by Cambridge University Press

References

185

Strong, T., & Paré, D. (Eds.). (2004). Furthering Talk: Advances in the Discursive Therapies. New York, NY: Kluwer/Plenum. Sun, L., Liu, X., Weng, X., Deng, H., Li, Q., Liu, J., & Luan, X. (2022). Narrative therapy to relieve stigma in oral cancer patients: A randomised controlled trial. International Journal of Nursing Practice, 28(4), e12926. Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict. In W. G. Austin, & S. Worchel (Eds.), The Social Psychology of Intergroup Relations (pp. 33–47). Monterey, CA: Brooks/Cole. Tajfel, H., & Turner, J. C. (1986). The social identity theory of intergroup behaviour. In S. Worchel & W. G. Austen (Eds.), Psychology of Intergroup Relations (pp. 7–24). Chicago, IL: Hall. Tedeschi, R. G., & Calhoun, R. G. (1995). Trauma and Transformation. Thousand Oaks, CA: SAGE Publications. Theeboom, T., Beersma, B., & Van Vianan, A. E. (2014). Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organisational context. The Journal of Positive Psychology, 9(1), 1–18. Thorne, A., McLean, K. C., & Lawrence, A. M. (2004). When remembering is not enough: Reflecting on self-defining memories in late adolescence. Journal of Personality, 72(3), 513–542. Tomkins, S. S. (1987). Script theory. In J. Aronoff, A. I. Rabin, & R. A. Zucker (Eds.), The Emergence of Personality (pp. 147–216). New York, NY: Springer. Toolis, E. E., & Hammack, P. L. (2015). The lived experience of homeless youth: A narrative approach. Qualitative Psychology, 2(1), 50–68. Van Dijk, J. A., Schoutrop, M. J., & Spinhoven, P. (2003). Testimony therapy: Treatment method for traumatised victims of organised violence. American Journal of Psychotherapy, 57(3), 361–373. Van Nieuwerburgh, C. (2017). An Introduction to Coaching Skills: A Practical Guide (2nd ed.). London, UK: SAGE Publications. Vromans, L. P., & Schweitzer, R. D. (2011). Narrative therapy for adults with major depressive disorder: Improved symptom and interpersonal outcomes. Psychotherapy Research, 21(1), 4–15. Watzlawick, P. (1996). The construction of “clinical realities.” In H. Rosen & H. T. Kuehlwein (Eds.), Constructing Realities: Meaning-Making Perspectives for Psychotherapists (pp. 55–70). San Francisco, CA: Jossey-Bass. Weber, N., Davis, K., & McPhie, L. (2007). Narrative therapy, eating disorders and groups: Enhancing Outcomes in rural NSW. Australian Social Work, 59(4), 391–405. Weine, S. M., Dzubur Kelanovic, A., Pavkovic, I., & Gibbons, R. (1998). Testimony therapy with Bosnian refugees: A pilot study. American Journal of Psychiatry, 155(12), 1720–1726. Weiss, D. S., & Marmar, C. R. (1997). The impact of events scale – Revised. In J. P. Wilson & T. Keane. (Eds.), Assessing Psychological Trauma and PTSD (pp. 339–441). New York: Guilford Press. White, M. (2000). Reflections on Narrative Practice: Essays and Interviews. Adelaide, South Australia: Dulwich Centre Publications.

Published online by Cambridge University Press

186

References

White, M. (2002). Addressing personal failure. International Journal of Narrative Therapy and Community Work, 3, 33–76. White, M. (2004). Narrative Practices and Exotic Lives: Resurrecting Diversity in Everyday Life. Adelaide, South Australia: Dulwich Centre Publications. White, M. (2006). Working with people who are suffering the consequences of multiple trauma: A narrative perspective. In D. Denborough (Ed.), Trauma: Narrative Responses to Traumatic Experiences (pp. 25–86). Adelaide, South Australia: Dulwich Centre Publications. White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. New York, NY: W. W. Norton & Company. Whitmore, J. (2009). Coaching for Performance: Growing Human Potential and Purpose. London, UK: Nicholas Brealey. Wiktorowicz, Q. (2005). Radical Islam Rising: Muslim Extremism in the West. Oxford: Rowman & Littlefield. Winslade, J., & Monk, G. (2000). Narrative Mediation: A New Approach to Conflict Resolution. San Francisco, CA: Jossey-Bass. Wong, G., & Breheny, M. (2018). Narrative analysis in health psychology: A guide for analysis. Health Psychology and Behavioural Medicine, 6(1), 245–261. Wright, J. (2002a). In the beginning: The role of myth in relating religion, brain science and mental well-being. Zygon, 53(2), 375–391. Wright, J. (2002b). Online counselling: Learning from writing therapy. British Journal of Guidance and Counselling, 30(3), 285–298. Wright, J., & Chung, M.C. (2001). Mastery or mystery? Therapeutic writing: A review of the literature. British Journal of Guidance and Counselling, 29(3), 277–291. Zachariae, R., & O’Toole, M. S. (2015). The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients: A systematic review and meta-analysis. Psycho-Oncology, 24(11), 1349–1359. Zaharias, G. (2018a). What is narrative-based medicine? Canadian Family Physician, 64(3), 176–180. Zaharias, G. (2018b). Learning narrative-based medicine skills. Canadian Family Physician, 64(5), 352–356. Zang, Y., Hunt, N., & Cox, T. (2013). A randomised controlled pilot study: The effectiveness of narrative exposure therapy with adult survivors of the Sichuan Earthquake. BMC Psychiatry, 13(1), 41. Zang, Y., Hunt, N., & Cox, T. (2014). Adapting narrative exposure therapy for Chinese earthquake survivors: A pilot randomised control feasibility study. BMC Psychiatry, 14, 262.

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Index

applied psychology, 6, 164 archetype, 49 arts, 7 Big Bang, 27 becoming rather than being, 157 career, 153 career counsellors, 154 clinical judgement, 137 clinical method, 139 clinical psychology, 164 clinical reflection, 141 coaching GROW model, 158 co-construction, 67 cognition, 28 coherence, 71 communication skills, 134 constructionism, 153 constructive memory, 37 contamination, 36–37 critical realism, 34 critical reflexivity, 67 culture, 30 master narrative, 42 culture wars, 32 deconstructing problematic dominant stories, 105 Default Mode Network, 29 depression, 8 diagnosis, 133 diary, 91 DSM/ICD, 102 earthquake, 125 eating disorders, 149 E-NET, 130 enlightenment, 31 ethics, 60–61, 68 evidence, weak, 6, 7

evolution, 29 expressive writing, 6, 12, 92–95, 165, 166 familiarisation, 69 free will, 24 general practitioner (GP), 133, 143, 147 god, 27 grounded theory, 68 group writing, 97 health psychology, 147 ICD/DSM, 166 identity, 35, 50–51, 152 illness, 136 individual differences, 26 interpretative phenomenological analysis (IPA), 68, 69, 84, 88 interview, 69 interview protocol, 83 Iraq, 126 journal, 91 KIDNET, 125 life interviews, 11, 164 life story interview, 74–76 LIWC, 95, 167 master narrative, 9, 10 conflicting, 43, 58–59 constraints, 59 culture, 42, 45 religion, 49 meaning, 38 medicine humanities, 135 memory, 24 methods, 10 multiculturalism, 36–37

187

https://doi.org/10.1017/9781009245333.016 Published online by Cambridge University Press

188 narrative characteristics, 18, 20 coaching, 14, 159 coherence, 73 definition, 3 dominant, 32 healing, 136 integration, 39 non-scientific, 2 root metaphor, 25, 26 root metaphor of all psychology, 22 science, 2 unifying theory and method, 24 writing, 12 narrative analysis, 63, 66 narrative and story, 16 narrative as science, 28 narrative exposure therapy (NET), 6, 14, 121, 165, 168 narrative interview, 64 narrative life interview, 11, 77–82, 168 narrative therapy, 12, 165 clients as experts, 111 components, 106 cult, 101 dialogical disruption, 110 double listening, 108, 109 evidence, 117 externalising focus, 107 personal agency, 106 problem is the problem, 107 redescription, 112 social and cultural conditions, 111 solution-focused, 112–113 thick descriptions, 109 thin description, 108 unique outcomes, 110 natural disasters, 121 neuroscience, 29 NICE guidelines, 121

Index pneumonia, 139 politics, 36–37 postmodern, 59 post-positivism, 103 poststructuralist, 100 post-traumatic stress disorder (PTSD), 88, 121 power, 139, 140, 144 powerlessness, 104 psychotherapy, 91 rationality, 31 RCT, 128, 166 re-authoring problematic dominant stories, 105 redemption, 77 refugees, 82–88, 124 rehabilitation therapy, 149 reliability and validity, 67, 71 remembering conversations, 106 science and humanities integration, 30 scientific method, 167 scientific paradigm, 165 self, 34 self-realisation, 31 social psychology, 46 social representations, 9 staff appraisal, 155 stories, 3 story analyst, 66 story teller, 66

Odyssey, 113–114

temporal fluidity, 67 testimony, 126–128 thematic analysis, 68, 69 therapeutic writing, 97 therapy formal and informal, 74 transsexuals, 88–90 trauma, 8, 104 traumatic stress, 23, 121

palliative care, 149 paradigmatic, 9

wokeism, 32 World War II, 65, 71

https://doi.org/10.1017/9781009245333.016 Published online by Cambridge University Press